Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jul;20(5):691-700.
doi: 10.1177/15589447241232094. Epub 2024 Feb 27.

Comparison of Intramedullary Screw Fixation, Plating, and K-Wires for Metacarpal Fracture Fixation: A Meta-Analysis

Cristina R DelPrete  1 , John Chao  2 , Bobby B Varghese  3 , Patricia Greenberg  4 , Hari Iyer  5 , Ajul Shah  5
Affiliations
Meta-Analysis

Comparison of Intramedullary Screw Fixation, Plating, and K-Wires for Metacarpal Fracture Fixation: A Meta-Analysis

Cristina R DelPrete et al. Hand (N Y). 2025 Jul.

Abstract

Background: Metacarpal fractures are common injuries with multiple options for fixation. Our purpose was to compare outcomes in metacarpal fractures treated with intramedullary screw fixation (IMF), Kirschner wires (K-wires), or plating.

Methods: A systematic literature review using the MEDLINE database was performed for studies investigating metacarpal fractures treated with IMF, plating, or K-wires. We identified 34 studies (9 IMF, 8 plating, 17 K-wires). A meta-analysis using both mixed and fixed effects models was performed. Outcome measures included mean Disabilities of the Arm, Shoulder, and Hand (DASH) scores, total active motion (TAM), grip strength, time to radiographic healing, and rates of infection and reoperation.

Results: Patients with IMF had significantly lower DASH scores (0.6 [95% confidence interval [CI], 0.2-1.0]) compared with K-wires (7.4 [4.8-9.9]) and plating (9.8 [5.3-14.3]). Intramedullary screw fixation also had significantly lower rates of reoperation (4%, [2%-7%]), compared with K-wires (11% [7%-16%]) and plating (11% [0.07-0.17]). Grip strength was significantly higher in IMF (104.4% [97.0-111.8]) compared with K-wires (88.5%, [88.3-88.7]) and plating (90.3%, [85.4-95.2]). Mean odds ratio time was similar between IMF (21.0 minutes [10.4-31.6]) and K-wires (20.8 minutes [14.0-27.6]), but both were shorter compared with plating (52.6 minutes [33.1-72.1]). There were no statistically significant differences in time to radiographic healing, TAM, or rates of reoperation or infection.

Conclusions: This meta-analysis compared the outcomes of metacarpal fixation with IMF, K-wires, or plating. Intramedullary screw fixation provided statistically significant lower DASH scores, higher grip strength, and lower rates of reoperation, suggesting that it is a comparable method of fixation to K-wires and plating for metacarpal fractures.

Keywords: anatomy; diagnosis; disability; fracture/dislocation; hand; outcomes; research and health outcomes; specialty; surgery.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA diagram indicating study selection process. Note. K-wires = Kirschner wires; IMF = intramedullary screw fixation; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

References

    1. Robinson LS, Sarkies M, Brown T, et al. Direct, indirect and intangible costs of acute hand and wrist injuries: a systematic review. Injury. 2016;47(12):2614-2626. doi: 10.1016/j.injury.2016.09.041 - DOI - PubMed
    1. MacDermid JC, McClure JA, Richard L, et al. Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario. BMC Musculoskelet Disord. 2021;22(1):996. doi: 10.1186/s12891-021-04849-7 - DOI - PMC - PubMed
    1. Nakashian MN, Pointer L, Owens BD, et al. Incidence of metacarpal fractures in the US population. Hand. 2012;7(4):426-430. doi: 10.1007/s11552-012-9442-0 - DOI - PMC - PubMed
    1. Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res. 2006;445:133-145. doi: 10.1097/01.blo.0000205888.04200.c5 - DOI - PubMed
    1. Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clin. 2013;29(4):507-518. doi: 10.1016/j.hcl.2013.09.004 - DOI - PubMed

MeSH terms

LinkOut - more resources