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

Abstract

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.

Keywords

• Antegrade K-wire
• Fifth metacarpal neck fracture
• Retrograde cross-pinning

Ethical Statement

This study was approved by the Ethics Committee of the Medical Faculty of Pamukkale University (dated 19.02.2025; number: E-60116787-020-657850/04). The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000.

Thanks

We thank all the study participants who made this study possible.

References

1. Gudmundsen T, Borgen L. Fractures of the fifth metacarpal. Acta Radiol. 2009;50(3):296-300. doi:10.1080/02841850802709201.
2. Van Onselen E, Karim R, Hage JJ, Ritt M. Prevalence and distribution of hand fractures. J Hand Surg Br. 2003;28(5):491-5. doi:10.1016/s0266-7681(03)00103-7.
3. Malik S, Herron T, Taqi M, Rosenberg N. Fifth metacarpal fracture. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.. https://www.ncbi.nlm.nih.gov/books/NBK470428/
4. Hussain MH, Ghaffar A, Choudry Q, Iqbal Z, Khan MN. Management of fifth metacarpal neck fracture (boxer's fracture): a literature review. Cureus. 2020;12(7):e9442. doi:10.7759/cureus.9442.
5. Padegimas EM, Warrender WJ, Jones CM, Ilyas AM. Metacarpal neck fractures: a review of surgical indications and techniques. Arch Trauma Res. 2016;5(3):e32933. doi:10.5812/atr.32933.
6. She Y, Xu Y. Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing. BMC Musculoskeletal Disorders. 2017;18(1):238. doi:10.1186/s12891-017-1592-3.
7. Low C, Wong H, Low Y, Wong H. A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Br. 1995;20(5):609-13. doi:10.1016/s0266-7681(05)80120-2.
8. Mejia A, Lichtig AE, Ghosh A, Balasubramaniyan A, Mass D, Amirouche F. The effect of metacarpal shortening on finger strength and joint motion: a cadaveric biomechanical study. J Hand Surg Glob Online. 2023;5(4):407-12. doi:10.1016/j.jhsg.2023.03.007.

9. Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am. 2004;29(4):689-93. doi:10.1016/j.jhsa.2004.03.002.
10. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand. 2014;9(1):16-23. doi:10.1007/s11552-013-9562-1.
11. Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clin. 2013;29(4):507-18. doi:10.1016/j.hcl.2013.09.004.
12. Ushijima T, Ogawa H, Kojima T. Clinical outcomes of retrograde percutaneous pinning for shaft fracture of metacarpal bone: a case series. J Orthop Case Rep. 2025;15(4):239-44. doi:10.13107/jocr.2025.v15.i04.5510.
13. Foucher G. “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995;20(3):S86-S90. doi:10.1016/s0363-5023(95)80176-6.
14. Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: locking plate versus K-wire?. Orthop Traumatol Surg Res. 2010;96(5):506-12. doi:10.1016/j.otsr.2010.02.009.
15. Hoang D, Vu CL, Huang JI. Evaluation of antegrade intramedullary compression screw fixation of metacarpal shaft fractures in a cadaver model. J Hand Surg Am. 2021;46(5):428.e1-428.e7. doi:10.1016/j.jhsa.2020.10.026.
16. Baydar M, Aydın A, Şencan A, Orman O, Aykut S. Comparison of clinical and radiological results of fixation methods with retrograde intramedullary Kirschner wire and plate-screw in extra-articular metacarpal fractures. Jt Dis Relat Surg. 2021;32(2):397-405. doi:10.52312/jdrs.2021.40.
17. Hudak PL, Amadio PC, Bombardier C, Beaton D, Cole D, Davis A, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med. 1996;29(6):602-8. doi:10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L.
18. Waljee JF, Kim HM, Burns PB, Chung KC. Development of a brief, 12-item version of the Michigan Hand Questionnaire. Plast Reconstr Surg. 2011;128(1):208-20. doi:10.1097/prs.0b013e318218fc51.
19. Sletten I, Nordsletten L, Hjorthaug G, Hellund J, Holme I, Kvernmo H. Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter-and intra-observer validity and reliability study. J Hand Surg Eur Vol. 2013;38(6):658-66. doi:10.1177/1753193412461582.
20. Wierer G, Plachel F, Winkler PW, Grossauer T, Quirchmayr M, Hoffelner T, et al. The “Trigonometric Technique” for simple measurement of volar angulation in boxers’ fractures. Orthop Traumatol Surg Res. 2020;106(8):1653-8. doi:10.1016/j.otsr.2020.06.018.
21. Manueddu CA, Della Santa D. Fasciculated intramedullary pinning of metacarpal fractures. J Hand Surg Br. 1996 Apr;21(2):230-6. doi:10.1016/s0266-7681(96)80104-5.
22. Chiu Y-C, Hsu C-E, Ho T-Y, Ting Y-N, Tsai M-T, Hsu J-T. Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture. J Orthop Surg Res. 2021;16(1):441. doi:10.1186/s13018-021-02575-3.
23. Rivera-Saldívar G, Rodríguez-Luna C, Orozco-Aponte N. [Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: retrograde vs. anterograde technique. Prospective study. Rev Esp Cir Ortop Traumatol. 2023;67(5):T378-86. doi:10.1016/j.recot.2023.06.013.
24. Vannabouathong C, Li P, Srikanth V, Chen M, Bhandari M, Kakar S. Comparing the efficacy and safety of metacarpal neck fracture treatments: a systematic review and network meta-analysis. J Hand Surg Glob Online. 2020;2(4):217-25. doi:10.1016/j.jhsg.2020.04.005.
25. Wong T, Ip F, Yeung S. Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br. 2006;31(1):61-5. doi:10.1016/j.jhsb.2005.06.022.
26. Thomas TL, Kachooei AR, Ilyas AM. Intramedullary K-wires versus alternate techniques for metacarpal shaft and neck fractures: a systematic review and meta-analysis. J Hand Microsurg. 2023;15(05):376-87. doi:10.1055/s-0042-1749410.
27. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res. 2011;63(S11):S240-52. doi:10.1002/acr.20543.
28. Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res. 2015;473(5):1747-54. doi:10.1007/s11999-014-4079-7.