The aim of this study was to compare the mid-term clinical and radiological outcomes of intramedullary K-wire and plate-screw fixation in multiple extra-articular metacarpal fractures, and to evaluate the impact of fracture localization on functional outcomes. This retrospective study included 46 patients with at least two metacarpal shaft fractures between January 2018 and December 2023. Twenty patients underwent plate-screw fixation, while twenty-six patients received intramedullary K-wire osteosynthesis. Grip strength was measured using a digital dynamometer. Pain intensity was assessed with the Visual Analog Scale (VAS), and functional status was evaluated using the Michigan Hand Outcomes Questionnaire (MHQ). All patients were followed for a minimum of 15 months. Clinical scores were compared according to surgical method and fracture localization. Grip strength was significantly higher in the K-wire group (p=0.013). No statistically significant difference was observed between the groups in MHQ or VAS scores. Analysis based on fracture localization revealed that grip strength was significantly lower in 2nd and 3rd metacarpal fractures (p=0.036), whereas higher grip strength and lower pain scores were recorded in 4th and 5th metacarpal fractures (p=0.044). K-wire fixation is less invasive and provides better mid-term grip strength outcomes. However, functional scores were comparable between both techniques. Regardless of the surgical method, fractures involving the 2nd and 3rd metacarpals were associated with poorer prognosis. Fracture patterns and localization should be considered in treatment planning. Level II – Single-center randomized controlled trial.
Topsakal et al. (Wed,) studied this question.