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