Clinical and patient-reported outcomes are similar for surgical fixation of a dorsally displaced fracture of the distal radius with Kirschner wires (K-wires) and non-surgical treatment with a traditional molded plaster cast, according to a study published by The BMJ.
For the study, researchers tracked the progress of 500 adults (average age 60, 83% women) who were treated at 36 of the UK’s National Health Service (NHS) hospitals for a displaced distal radius fracture between January 2017 and March 2019. Patients were randomized to surgical fixation with K-wires (245) or a cast (255) after manipulation of their fracture.
The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months. The PRWE include questions about pain, function, and disability, with an overall score from 0 (best) to 100 (worst). Secondary outcomes were PRWE score at 3 and 6 months, quality of life, and complications, including the need for later surgery.
A total of 395 (79%) patients completed the follow-up. Although both groups showed improvement over the 12-month period, no statistically significant difference was seen in the PRWE score at 3, 6, or 12 months (average score 21.2 in the cast group and 20.7 in the K-wire group).
Health-related quality of life also showed a similar pattern of recovery in both groups over time, and again the difference was not significant.
However, 1 in 8 patients treated with a molded cast needed surgery for loss of fracture position in the first 6 weeks after their injury compared with just 1 patient in the K-wire group. Other complications were rare, with no evidence of a difference between the 2 groups (28 complications in the cast group compared with 22 in the K-wire group).
The researchers acknowledge some limitations, including the fact that neither the treating clinicians nor the participants could be blind to the interventions.
Nevertheless, this was a large trial involving adults of all ages and the results are based on validated patient-reported outcomes, reflecting the care provided across a healthcare system. As such, the authors concluded that, “surgical fixation with K-wires did not provide better wrist function at 12 months compared with a [molded] cast, indicating that a cast is an acceptable first-line treatment following manipulation of a dorsally displaced fracture of the distal radius.
“Cast treatment avoids the expense and risks of surgical fixation for 7 out of 8 patients. However, careful follow-up is needed as 1 in 8 patients treated with a cast required subsequent surgical intervention as the fracture reduction could not be maintained.”
Costa ML, Achten J, Ooms A, et al. Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial. BMJ. 2022 Jan 19;376:e068041. doi: 10.1136/bmj-2021-068041.