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January 31, 2022
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K-wire fixation did not improve wrist function in distal radius fractures vs molded cast

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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
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.