Antegrade Intramedullary K-Wire or Retrograde Cross-Pinning? A Prospective Midterm Comparison

Objective: This study aimed to compare the mid-term clinical and radiological results of antegrade intramedullary (IM) K-wire fixation and retrograde cross-pinning techniques in unstable fifth metacarpal neck fractures.Methods: In this study (January 2024–January 2025), 44 patients with preoperative neck angulation >30° underwent closed reduction followed by antegrade IM K-wire (n=16) or retrograde cross-pinning (n=28). Radiographs were assessed for metacarpal neck angle and residual shortening. Clinical outcomes—range of motion (ROM); metacarpophalangeal (MCP)/proximal interphalangeal (PIP)/distal interphalangeal (DIP) and total ROM), pain (visual analog scale (VAS)), DASH, and Brief Michigan Hand Questionnaire (bMHQ)—were recorded at 4 weeks, 3, and 6 months by assessors blinded to technique.Results: Baseline characteristics were comparable. Postoperatively, the antegrade approach was associated with a lower neck angle and less residual shortening (p<0.05). At 4 weeks, the antegrade group was superior in MCP, PIP, and total ROM, while DIP was similar. At 3 months, the MCP/PIP benefit continued, but DIP and total ROM showed no difference. By 6 months, ROM differences were not significant. DASH and VAS were lower at 4 weeks and 3 months, and bMHQ was higher at 4 weeks; no between-group differences remained at 6 months. Exploratory findings indicated an earlier return to work and less work disability in the antegrade group.Conclusion: Antegrade IM K-wire fixation leads to earlier functional recovery, less pain, and better early alignment (less residual shortening), while outcomes are similar by 6 months. Technique choice should be tailored based on early recovery goals, soft-tissue considerations, and patient priorities.