Compari̇son of closed reducti̇on percutaneous pi̇nni̇ng vs. open reducti̇on plate-screw fi̇xati̇on techni̇ques i̇n...

PURPOSE: The aim of this study was to compare the two prevalent techniques of open reduction internal fixation (ORIF) and closed reduction percutaneous pinning (CRPP) in the management of unstable metacarpal shaft fractures, thus guiding in selecting the appropriate treatment method through an evaluation of functional, morphologic, and performance-based criteria. METHODS: We retrospectively analyzed 96 patients (plate-screw:n=39; K-wire: n=57) who underwent surgery between 2017 and 2020 for isolated metacarpal shaft fractures, excluding the first metacarpal. QuickDASH, Modified Mayo Wrist Score (MMWS), metacarpophalangeal range of motion (ROM), grip strength, and metacarpal shortening in comparison to the contralateral hand were assessed at the one-year follow-up. The parameters were subjected to statistical comparison between the groups. RESULTS: The groups exhibited similar demographics. The QuickDASH, MMWS distribution, and ROM exhibited similar outcomes across the groups (p = 0.40; p = 0.10; p = 0.29, respectively). The percentage of grip strength relative to the unaffected side was higher in the plate group (96.7 ± 9.2 vs. 89.2 ± 14.5; p = 0.002; Holm–Bonferroni adjusted p = 0.012; medium effect size). Radiographic shortening and the proportion of patients with clinically relevant shortening (≥ 2 mm) were quantitatively lower with the plate-screw group, although complications occurred more frequently; nonetheless, these secondary variations did not consistently achieve statistical significance following adjustments for multiple comparisons and covariates. CONCLUSIONS: While functional scores and joint range of motion were similar between groups at the end of the first year, normalized grip strength was significantly higher in the plate-screw group compared to the K-wire group. Nonetheless, complication rates were higher in the plate-screw group. Therefore, in cases for whom the preservation of grip strength is paramount and soft tissue problems are tolerable, plate-screw fixation may be considered a better option; conversely, when soft tissue preservation and minimal invasiveness are prioritized, K-wire fixation is the more suitable approach. The decision must be tailored according to the fracture pattern and the patient’s expectations. LEVEL OF EVIDENCE: Level III, Retrospective Comparative Cohort Study.