Clinical Outcomes of Cross Versus Adjacent Metacarpal Kirschner Wire Fixation for Fifth Metacarpal Neck Fractures: A Retrospective Comparative Study

Objective To compare the clinical efficacy of cross Kirschner wire fixation and adjacent metacarpal Kirschner wire fixation in the treatment of fifth metacarpal neck fractures, and to provide evidence to support surgical decision-making. Methods A retrospective analysis was conducted on the clinical data of 45 patients with fifth metacarpal neck fractures treated between September 2019 and May 2025. According to the intraoperative fixation method, patients were divided into a control group (cross Kirschner wire fixation, n = 26) and an experimental group (adjacent metacarpal fixation, n = 19). There were no statistically significant differences between the two groups in baseline characteristics, including age, sex, mechanism of injury, and fracture type (P > 0.05). Bone healing time, postoperative volar angulation, DASH score, complication rate and grip strength recovery were compared between the two groups. Results All patients were followed up for at least 6 months. The DASH score of the experimental group at 6 months after surgery was significantly lower than that of the control group (12.8 ± 2.2 vs 16.9 ± 4.0, P < 0.01); the average ratio of postoperative grip strength recovery to the healthy side in the experimental group was 84.7 ± 8.3%, which was significantly better than 78.9 ± 8.8% in the control group (P < 0.05). There was no statistically significant difference in bone healing time between the two groups (5.2 ± 0.5 weeks vs 5.5 ± 0.6 weeks, P > 0.05). There was no statistically significant difference in the maintenance effect of the fifth metacarpal neck-shaft angle between the two groups (average postoperative angulation 14.2 ± 4.6° vs 15.7 ± 4.5°, P > 0.05). In the control group, 3 cases of pin tract infection and 5 cases of metacarpophalangeal joint stiffness occurred; 1 case of pin tract infection occurred in the experimental group. Conclusion Adjacent metacarpal Kirschner wire fixation may offer advantages in maintaining reduction, promoting functional recovery, and reducing postoperative complications It is especially suitable for stable and mildly comminuted fractures, and can be used as an effective alternative to cross Kirschner wire fixation.