Taxan published the localized NES version in April 1989, making it one of the earliest Fist of the North Star products released in the U.S. alongside Viz Communications' English adaptation of the manga.

Fist of the North Star is a single-plane beat-'em-up in which the player (as Kenshiro) proceeds through the game by walking from left to right, using his martial arts of Hokuto Shinken[b] to defeat enemies.

Each boss in the game has a weak point that will result in massive damage if the player strikes it with the proper attack before hitting any other part of the body, along with a greater bonus after the stage is cleared.

[e] As a result, the game only covers the Tentei story arc and ends prematurely with an optional final boss battle against the Nameless Shura.

Bronza substitute Shōki's role in the anime as the General of Red Light and is described as the only martial artist outside the Hokuto Shinken school to had mastered the ultimate technique of Musō Tensei.