K-wire Versus Plate–Screw Fixation in Fifth Metacarpal Neck Fractures: Functional Outcomes and Treatment Cost

Abstract

Background: Fifth metacarpal neck fractures are common hand injuries, and various surgical techniques have been described for their management. However, the comparative effectiveness and cost implications of these techniques remain controversial.Methods: This retrospective study included 30 patients treated between 2023 and 2024. Patients were divided into two equal groups: K-wire fixation (n=15) and plate–screw fixation (n=15). Outcomes included QuickDASH (qDASH), grip strength measured with a dynamometer, and metacarpophalangeal (MCP) joint range of motion (ROM) recorded as active and passive. Grip strength was analyzed within-patient as operated hand versus contralateral healthy hand. Direct implant-related cost was obtained from the hospital billing system.Results: All fractures achieved radiographic union. One wound infection and one loss of reduction requiring revision occurred in the plate–screw group; no complications were observed in the K-wire group. Functional outcomes were comparable between groups: qDASH 4.69±3.03 vs 5.60±3.21 (p=0.479). Operated-hand grip strength was 41.1±7.7 kg vs 38.0±8.7 kg (p=0.253), and contralateral healthy-hand grip strength was 40.0±8.9 kg vs 38.0±8.1 kg (p=0.506). Active and passive MCP flexion and extension were similar between groups (p=0.471, p=0.607, p=0.823, and p=0.495). Implant-related cost was markedly lower with K-wire fixation (52.0±12.6 TL vs 9,941.3±827.9 TL; p