K-wire fixation did not improve wrist function in distal radius fractures vs molded cast

ByCasey Tingle

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Published results showed patients with dorsally displaced distal radius fractures who underwent surgical fixation with K-wires did not experience better wrist function at 12-months compared with patients who received a molded cast.

“If a closed reduction of the fracture can be achieved, clinicians may consider the application of a molded plaster cast as a safe and cost-effective alternative to surgical fixation,” Matthew L. Costa, told Healio. “This will save seven of eight patients from needing to have surgery, but careful follow-up is required to identify the one in eight who lose fracture reduction in the cast. Surgical intervention is still required when a closed reduction of the fracture cannot be achieved.”

Of the patients with dorsally displaced distal radius fractures who received a molded cast, 13% needed surgical fixation for loss of fracture position in the first 6 weeks vs. 0.4% of patients who received surgical fixation with K-wires. Data were derived from Costa ML, et al. BMJ. 2022;doi:10.1136/bmj-2021-068041. — Of the patients with dorsally displaced distal radius fractures who received a molded cast, 13% needed surgical fixation for loss of fracture position in the first 6 weeks vs. 0.4% of patients who received surgical fixation with K-wires. Data were derived from Costa ML, et al. *BMJ*. 2022;doi:10.1136/bmj-2021-068041.

Costa and colleagues randomly assigned 500 adult patients with a dorsally displaced fracture of the distal radius to receive either surgical fixation with K-wires (n=245) or a molded cast (n=255). Researchers considered the patient-rated wrist evaluation (PRWE) score at 12 months as the primary outcome measure, and secondary outcomes included PRWE score at 3 and 6 months, quality of life and complications, including the need for surgery due to loss of fracture position in the first 6 weeks.

Matthew L. Costa

While both groups showed improvements in the PRWE score during the 12 months after injury, results showed no statistically significant differences between the two groups at 3-, 6- or 12-month follow-up after randomization. Similarly, researchers found no differences in EuroQol-5D-5L health-related quality of life and VAS scores between the K-wire and cast groups at any time point. Researchers noted 13% of patients in the cast group needed surgical fixation for loss of fracture position in the first 6 weeks vs. 0.4% of patients in the K-wire group.

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Sources/Disclosures

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Source:

Costa ML, et al. BMJ. 2022;doi:10.1136/bmj-2021-068041.

Disclosures: Costa reports being a senior investigator for the National Institute for Health Research and a member of the general board for the National Institute for Health Research Health Technology Assessment funding stream.