Transverse inter-metacarpal K-wire with Nice-knot augmentation versus mini-plate fixation for second-fifth metacarpal...

Metacarpal shaft fractures require techniques that balance stability with rapid rehabilitation. Conventional crossed K‑wires are minimally invasive yet provide limited interfragmentary compression and may compromise reduction, whereas mini‑plates offer rigid fixation at the expense of larger incisions, longer operative time, and higher cost. Building on these trade‑offs, we evaluated a transverse K‑wire technique across adjacent metacarpals augmented with the Nice knot. In our cohort, this approach delivered perioperative efficiencies-no secondary surgery, shorter operative time, smaller incisions, and lower hospitalization costs-without increasing complications. Early joint mobility at 4 weeks was statistically greater with the Nice knot approach, but the effect size was small and likely of limited clinical relevance.

We performed a retrospective cohort analysis of patients treated for second to fifth metacarpal shaft fractures at our institution between December 2021 and January 2025. Two groups were compared: (1) Transverse K‑wire fixation across adjacent metacarpals combined with Nice knot suture augmentation (Nice knot group) and (2) conventional open reduction and internal fixation with mini‑plates (plate group).Outcome measures included average hospitalization cost, operative time, incision length, postoperative metacarpophalangeal joint range of motion (ROM) at 2,4 and 6 weeks, grip strength recovery, time to union, Disabilities of the Arm, Shoulder and Hand (DASH) score, and complication rate. Baseline variables (age, sex, dominant‑hand involvement, preoperative waiting period) were assessed for group comparability.

Baseline characteristics-including patient age, sex, dominance of the injured hand, and time from injury to surgery-did not differ significantly between the Nice knot and plate groups (all P > 0.05). Relative to the plate group, the Nice knot group had a 29.3% lower mean hospitalization cost (432.7 ± 43.7 EUR vs. 611.5 ± 94.5 EUR; P < 0.01) and a 38.8% shorter mean operative time (23.2 min vs. 37.9 min; P < 0.01), accompanied by a smaller median incision length (2.5 cm vs. 4.7 cm; P < 0.01). At 4 weeks postoperatively, the median metacarpophalangeal joint range of motion was greater in the Nice knot cohort (82°vs 80°; P = 0.039). By 6 weeks, there were no significant between‑group differences in joint mobility, grip strength recovery, or time to fracture union (all P > 0.05). At the primary 6‑month endpoint, DASH scores did not differ significantly between groups (P > 0.05). Complication rates were similarly low (3.03% vs. 3.33%; P = 1.000), indicating that trans‑metacarpal K‑wire fixation with Nice knots does not increase the risk of adverse events relative to plate fixation.At 6 months, DASH difference was 1.0 (95% CI - 0.8 to 2.8), meeting non‑inferiority versus Δ = 10.

Transverse K‑wire fixation across adjacent metacarpals combined with Nice knot suture augmentation achieved comparable 6‑month functional outcomes to plate fixation, while reducing cost, operative duration, and incision length without increasing complication risk. A small, statistically significant advantage in MCP AROM at 4 weeks (≈ 2°) was observed, but its clinical relevance is likely limited. These findings support this technique as a safe, minimally invasive, and economically favorable option for selected displaced oblique or spiral metacarpal shaft fractures.