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Introduction/background Metacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents (RTA), fall, and assault. The classification is based on the site and pattern of fracture. High-level evidence is lacking for the management of metacarpal fractures. The primary goals of treatment are to achieve acceptable alignment, stable reduction, strong bony union, and unrestricted motion. It can be managed by non-operative methods like close reduction and splintage. Operative management will be required if there is shortening, rotation, and angulation in different planes including close reduction and fixation with percutaneous intramedullary pining/k-wires and open reduction and fixation with screws, plates (compression/locking), and external fixators. This study was done to compare the efficacy of k-wire, screws, and plates in the management of metacarpal fractures and their outcomes based on their union, postoperative pain, range of movement, and grip strength in a tertiary care center, i.e., Liaquat National Hospital and Medical College. Methods It was a retrospective study conducted at the Department of Plastics and Reconstruction Surgery, of a tertiary care hospital. A total of 113 patients who were operated upon for metacarpal fracture were included in the study (open/close) without soft tissue loss or tendon injury, were divided into three groups according to the technique of fracture fixation, i.e., group 1 (k-wire), group 2 (screw), and group 3 (plates). The data like post-operative pain (visual analog scale, VAS) and radiological evidence of union were extracted from the registry. All the patients were called for follow-up in the outpatient department. Out of 113, 97 patients showed up for follow-up and were examined by a hand surgeon, and range of movement (goniometer) and grip strength (sphygmomanometer method) were assessed. Results A total of 97 patients were included in the study (male 66%, female 34%). Group 1 (K-wire) includes n = 61 (62.9%), group 2 (screw) n = 15 (15.5%), and group 3 (plate) n = 21 (21.6%). The mean follow-up time was 12 + 2 weeks after the surgery for post-operative pain and radiological evidence of union while 24 + 6 months for a range of movement and grip strength. Less post-operative pain was noted in group 1 patients while no significant difference was noted in the evidence of radiological union in all groups. Range of movement was better in group 1 patients (89.74 + 0.750) than in group 2 (80 + 0.37°) or group 3 (80.2 + 0.62°). The grip strength (compared to the normal contralateral hand) was normal in the majority of the patients in group 1, i.e., 94% while it was 80% in group 2 and 82% in group 3. Conclusion The significance of these reported findings suggests that open reduction and internal fixation with screw or plate might be a less preferable surgical technique in comparison to k-wire fixation in the treatment of a metacarpal fracture., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Fatima et al.)