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We present two cases of complex metacarpal fractures treated with an intramedullary locking nail. This is an emerging fixation method that minimizes tissue insult, provides sufficient stability, and allows early mobilization. Locking nails accommodate the capture of fractured fragments in complex unstable patterns and provide longitudinal and rotational stability. The described intrafocal technique is intended to improve coaxial placement of the wire into the medullary canal., Competing Interests: Dr Mercer has association/financial involvement with Skeletal Dynamics (speaker’s bureau) and Axogen (speaker’s bureau). No benefits in any form have been received or will be received by the other authors related directly to this article., (© 2024 The Authors.)