Outcomes of buried intramedullary k-wires versus low profile miniplates for metacarpal fracture management in adult – a prospective cohort study

Background & Aim: Improper management of metacarpal fractures can impair hand function. Although techniques like buried K-wire and low-profile miniplate fixation are used, no clear evidence indicates the best method. We compare their outcomes in function, union, and complications rate. Patients & Methods: A prospective cohort study was conducted at a single tertiary-level center. A total of 87 patients with metacarpal fractures were included and divided into two groups: 43 patients were fixed with buried intramedullary K-wires, and 44 patients were managed with a low-profile plate. All patients were followed for 3 ms, and results were analyzed based on subjective and objective criteria (PVAS, Q-DASH, grip strength, TAM, radiology assessments of union and residual deformity, complications, operative time, and time to union). Results: Most patients (95.3% versus 97.7%) achieved successful union, with mean times to union of 8.32±1.24 wk and 8.16±1.37 wk, respectively; P =0.66. No significant differences were found in PVAS, Q-DASH, TAM, time to radiological union, or residual deformities at the last follow-up. Although there were no significant differences in final functional outcomes, such as grip strength ( P =0.86), the K-wire group experienced significantly shorter operative times and less time off work. Conclusion: Buried intramedullary K-wires and miniplate fixation are effective techniques for managing metacarpal fractures, showing comparable outcomes in fracture union, functional outcome, and complication rates. However, buried K-wires are recommended when short operative time and rapid rehabilitation are priorities. Future studies with larger patient groups are needed to draw definitive conclusions on these points.