BACKGROUND The vast majority of metacarpal bone fractures are stable and are treated conservatively; however, when surgical intervention is to be preferred, many different operative procedures have been described. The purpose of this prospective study was to assess the anatomic and functional outcome of percutaneous transverse fixation with Kirschner wires (K-wires) of closed metacarpal neck, shaft. and intra-articular fractures of the base of the fifth metacarpal. METHODS Twenty-four consecutive patients with 25 closed metacarpal fractures were treated with this technique between 1999 and 2001. Under fluoroscopy, closed reduction and osteosynthesis with three K-wires, one proximally and two distally, was performed on the fracture site. All patients were reviewed clinically and radiologically after 3 weeks, 6 weeks, and 3 months. RESULTS The postoperative dorsal angulation ranged from 0 to 3 degrees. No measurable metacarpal shortening was observed. Callus formation was obvious in all fractures at 6 weeks. No complications were recorded, and all patients were cosmetically and functionally satisfied. CONCLUSIONS Treatment of closed metacarpal neck, shaft, and intra-articular fractures of the base of the fifth metacarpal with percutaneous transverse pinning, using two K-wires distally and one proximally, has shown excellent functional and anatomic outcome.