Abstract: BACKGROUND: Fractures of the fifth metacarpal shaft are common in the clinic, and surgical treatment is mostly performed with open reduction plate fixation, but postoperatively, most patients require removal of the internal fixation and require secondary hospitalization. Transcutaneous fixation with a Kirschner wire has many advantages, such as less trauma, small incision, and no need for reoperation.
OBJECTIVE: To comparatively analyze the clinical efficacy of percutaneous fixation of a Kirschner wire with miniplate placement in the transverse plane for treatment of the fifth metacarpal shaft fracture. 
METHODS: A total of 60 patients who underwent surgery for the fifth metacarpal shaft fracture at Binzhou Medical University Hospital between May 2018 and May 2020 were retrospectively analyzed and divided into two groups according to the operation method. 30 patients in the plate group were treated with open reduction miniplate internal fixation; 30 patients in the Kirschner wire group were treated with closed reduction and percutaneous fixation with a Kirschner wire (of which 5 patients were treated with mini-incision incision assisted fixation). The length of hospital stay, operation time, incision healing grade, incision length, intraoperative blood loss, intraoperative fluoroscopy number, and postoperative complications were compared between the two groups. The fracture healing time, grip strength, and the motion range of the fifth metacarpophalangeal joint were recorded in the two groups, and the functional outcomes of the fingers were evaluated by the total active movement method. 
RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 13-18 months. The differences in hospital stay, operation time, and incision healing grade between the two groups were not statistically significant (P > 0.05). (2) The amount of intraoperative blood loss and incision length in the Kirschner wire group were less than those in the plate group (P < 0.05). The number of intraoperative fluoroscopies in the plate group was less than that in the Kirschner wire group (P < 0.05). There was no significant difference in the fracture healing time between the two groups (P > 0.05). (3) At the last follow-up, the efficacy was evaluated according to the total active movement method. The excellent and good rate was 87% in the Kirschner wire group and 90% in the plate group, with no significant difference. There were no significant differences between the two groups in the motion range and grip strength of the fifth metacarpophalangeal joint at the last follow-up (P > 0.05). (4) Pin tract infection occurred in one case after Kirschner wire placement, which improved after giving iodophor to enhance the dressing change. There was 1 case of pin tail irritating skin symptoms, which resolved after the removal of the Kirschner wires. There were 12 patients in the plate group who were hospitalized after 12 months for personal reasons for plate removal, and all in the Kirschner wire group were removed on an outpatient basis. In the plate group, three patients developed sensory numbness of the skin on the dorsal side of the distal fifth metacarpal and the dorsal side of the little finger, which resolved gradually with oral administration of mecobalamin after surgery. There were no instances of nonunion and refracture with internal fixation in either group. (5) Our results showed that both of these surgical procedures achieved good results in the treatment of fifth metacarpal shaft fracture with excellent functional recovery of the fingers, but the transverse fixation with percutaneous Kirschner wire has many advantages, such as less trauma, small incision, low cost, and convenient removal of internal fixation. 

Key words: miniplate, Kirschner wires, transverse fixation, fifth metacarpal shaft fracture, metacarpal fracture, internal fixation