Comparative Outcomes of Kirschner Wire Fixation Versus Locking Plate Osteosynthesis in Fifth Metacarpal Neck Fractures: A 20-Year Retrospective Analysis

Background and Objectives: Fifth metacarpal neck fractures are commonly encountered in hand surgery, yet optimal surgical fixation remains debated. This study compares Kirschner wire (K-wire) fixation and locking plate osteosynthesis in terms of radiological and functional outcomes. Materials and Methods: A retrospective cohort of 30 patients (mean age 45) from 2003–2022 was reviewed. Patients underwent either antegrade K-wire fixation or dorsal/volar locking plate fixation. Outcomes assessed included union time, angular and length deformity correction, return to work, and complication rates. Results: Both groups achieved similar final angulation correction (85%, p = 0.72). K-wire fixation achieved significantly faster radiographic union (K-wire: 3.5 months; plate: 4.5 months, p = 0. 019). K-wires allowed earlier intervention (6.0 (3.0–9.0) vs. 14.0 (9.0–22.0) days to surgery, p < 0.05) but had a 6.7% malunion rate. Plating allowed earlier return to work and avoided pin-tract issues. Functional scores (QuickDASH) and grip strength restoration (>90%) were statistically similar. Conclusions: Both K-wire fixation and locking plate osteosynthesis achieved bone union and satisfactory functional recovery in this retrospective cohort. However, given the small sample size and observational nature of the study, surgical selection should be tailored to individual patient presentation and surgeon preference until larger prospective trials are available.