Vol. 11, Issue 4 (2025)

Background: Metacarpal fractures are among the most common upper limb injuries and can result in significant functional impairment if not properly managed. Various fixation techniques have been developed to achieve optimal stability and allow early mobilization. Among them, Kirschner wire (K-wire) and mini-plate fixation are widely used, yet the comparative incidence of postoperative complications remains a subject of debate.
Aim of the study: To compare the incidence of postoperative complications and functional outcomes between K-wire and mini-plate fixation in patients with metacarpal shaft fractures.
Methods: This prospective comparative study was conducted at the Department of Orthopedic Surgery, Bangladesh Medical University, Dhaka, from January 2023 to March 2025. Twenty-eight patients with closed metacarpal shaft fractures were randomly allocated into two equal groups: K-wire fixation (N=14) and mini-plate fixation (N=14). Postoperative complications, pain (VAS), hand function (QuickDASH), total active motion (TAM), grip strength, and time to bony union were recorded and compared using appropriate statistical tests in SPSS version 26.
Results: The mean operative duration was significantly shorter for K-wire fixation (23.57±7.57 min) compared to mini-plate fixation (41.79±8.23 min; P=0.001), while bone union occurred earlier in the mini-plate group (7.86±1.03 weeks; P=0.044). The mini-plate group demonstrated lower postoperative pain (VAS at 12 weeks: 0.71±0.73 vs. 1.50±0.86; P=0.027) and better functional recovery (QuickDASH at 12 weeks: 7.79±3.55 vs. 11.53±5.66; P=0.039). Total active motion and grip strength were also superior at 12 weeks in the mini-plate group (p<0.05). Postoperative complications were higher in the K-wire group, mainly stiffness (21.4%) and pin tract infection (14.3%), whereas the mini-plate group reported only one case of superficial wound infection. At 6 weeks, excellent outcomes were achieved in 71.4% of the mini-plate group and 50.0% of the K-wire group (p>0.05).
Conclusion: Both fixation methods are effective for treating metacarpal shaft fractures. However, mini-plate fixation provides faster recovery, earlier bone union, and fewer complications compared to K-wire fixation, although long-term functional outcomes are comparable.