Plates or K-Wires Fixation for Fifth Metacarpal Neck Fractures? A Comparative Study

Background: Metacarpal neck fractures account for approximately half of all hand fractures; however, there is no consensus on which surgical approach should be used for these fractures. This study aimed to compare the clinical and radiological outcomes of open reduction internal fixation (ORIF) and closed reduction percutaneous pinning (CRPP) for fifth metacarpal neck fractures. Methods: A total of 71 patients who underwent ORIF or CRPP for fifth metacarpal neck fractures between 2020 and 2024 were retrospectively evaluated. Patients were divided into two groups: ORIF (n = 31) and Kirschner (K)-wire (n = 40). Patient characteristics, follow-up durations, clinical outcomes and complications were examined and compared between the two groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) scores. The grip strength of the patients was measured on the contralateral arm using a Jamar dynamometer and compared between the groups. Angulation and shortening of the fifth metacarpal were measured based on preoperative and postoperative radiographs. Results: There was no statistically significant difference in clinical and functional outcomes between the two groups. Postoperative grip strength, radiological results (angulation and shortening) and follow-up duration were similar between the groups. The complication rate was significantly higher in the ORIF group than in the K-wire group. Conclusions: ORIF was not superior to CRPP in the surgical management of fifth metacarpal neck fractures. Considering the higher complication rate, the use of open reduction plate screw fixation as the first option for fifth metacarpal neck fractures is not recommended. Level of Evidence: Level III (Therapeutic).