An Analysis of the Results of Intramedullary K-wire Fixation versus Plating in Fractures of the Metacarpal Shaft

BACKGROUND: Fractures of the metacarpal bones are common injuries of the hand that can be managed surgically with K-wire, intramedullary screws or plates. The study aimed to compare the radiological and functional outcomes of metacarpal shaft fractures treated with K-wire and plate fixation. METHODOLOGY: A prospective study comprising 100 patients with metacarpal shaft fractures was recruited in a nonrandomized manner and divided into two groups ( n = 50 per group) and followed up for 9 and 14 months. Participants in one group were fixed using K-wire, while fractures in the other group were fixed using plates. The outcome variables included time for union, functional outcomes (Disability of the Shoulder, Arm, and Hand scores), pain scores (Visual Analogue Scale [VAS]), metacarpophalangeal joint-range of motion (MCPJ-ROM) (using single-axis manual goniometry), and possible complications. RESULTS: The median time of union was around 14 weeks in the plate group when compared to 17 weeks in the K-wire group ( P = 0.001). Overall functional outcomes were significantly better among participants in the plate group after 9 and 14 months, respectively ( P = 0.001). However, the median MCP joint active ROM (A-ROM) was found to be around 79.2° (88%) and 84.6° (94%) in the plating group and the K-wire group, respectively, at the end of 14 months. Median pain score was around 2 and 3 in the K-wire and the plating groups at the end of 9 months, respectively ( P = 0.001), but were the same at the end of 14 months. Median flexion MCPJ-AROM was better among participants fixed with K-wire both after 9 months (73.8° vs. 64.8°) and 14 months (84.6° vs. 79.2°), respectively. In terms of complications, there were 3 (6%) nonunion rates and 6 (3%) pin tract infections among the K-wire group, whereas there was only one case of nonunion among the plating group at the 14 th month ( P = 0.041). CONCLUSIONS: Fixing metacarpal fractures using plates resulted in better overall functional outcomes with early union of fracture segments. However, pain scores were less in the K-wire group with better MCPJ-ROM among participants.