Intramedullary K-Wire with Immediate Mobilisation versus Percutaneous Transverse K-Wire Fixation for Transverse Metacarpal Shaft Fractures.

Background: Transverse metacarpal shaft fractures commonly require surgical fixation, yet optimal postoperative management remains controversial. Although intramedullary (IM) Kirschner wire (K-wire) fixation allows early motion, many surgeons continue to apply postoperative splinting due to concerns about stability. We aim to determine if a single IM K-wire fixation without immobilisation yields better outcomes and faster recovery of hand function. Methods: A single-centre, prospective and randomised controlled trial was conducted between November 2024 and November 2025 involving isolated transverse fractures of the second to fifth metacarpal shafts. Twenty patients were randomised to single buried IM K-wire fixation without postoperative immobilisation (Group A) or percutaneous transverse K-wire fixation followed by 4 weeks of splinting (Group B). Outcomes included metacarpophalangeal (MCP) joint range of motion (ROM), disabilities of arm, shoulder and hand (DASH) score, healing and complications, assessed at 4, 8 and 12 weeks. Results: Group A demonstrated significantly superior MCP joint ROM and lower DASH scores at 4 weeks postoperatively, with differences exceeding the MCID threshold. After K-wire removal, no differences in ROM or DASH scores were observed at 8 and 12 weeks. All patients achieved bone union. No malrotation, loss of reduction, wire migration, infection or fixation failure occurred in either group. Conclusions: Single IM K-wire fixation without postoperative splinting is safe and provides earlier functional recovery compared with conventional transverse K-wire fixation with immobilisation without affecting the final outcomes. Early hands-free mobilisation facilitates faster restoration of ROM and daily hand function without compromising fracture healing. Level of Evidence: Level II (Therapeutic).