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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAndrew C. Gray, MD, Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom, presented the results of a recent study showing no difference between the use of Kirschner wires (K-wires) and volar locking plates for fracture repair in patients with dorsally displaced fractures of the distal radius. K-wire fixation was less expensive, and surgery took less time [Costa ML et al. BMJ. 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cp id=\u0022p-2\u0022\u003EAndrew C. Gray, MD, Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom, presented the results of a recent study showing no difference between the use of Kirschner wires (K-wires) and volar locking plates for fracture repair in patients with dorsally displaced fractures of the distal radius. K-wire fixation was less expensive, and surgery took less time [Costa ML et al. \u003Cem\u003EBMJ.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESurgical stabilization options for displaced and dorsally angulated distal radial fractures include the use of external fixation, dorsal or volar plates, and K-wires. Despite several Cochrane reviews over the last 10 years, the evidence for optimal treatment is inconclusive. The Distal Radius Acute Fracture Fixation Trial [\u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN31379280\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN31379280\u003C\/a\u003E] was a multicenter randomized controlled trial to compare K-wire fixation with locking-plate fixation. Consenting adult patients with a dorsally displaced distal radial fracture were eligible to participate provided the injury was \u0026lt; 2 weeks old and the surgeon believed that the patient would benefit from fracture fixation. Patients with fractures extending \u0026gt; 3 cm from the radiocarpal joint and those with an open fracture with a Gustillo grade \u0026gt; 1 were excluded, as were those in whom the fracture or joint surface could not be reduced by closed or indirect means. The primary outcome measure was improvement in the Patient-Rated Wrist Evaluation (PRWE) in the 12 months after surgery. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand scores, radiographic changes, complications, and health economics (EuroQol-5D, resource use).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study comprised 461 adult patients with a dorsally displaced distal radial fracture who were randomized to either K-wire fixation (n = 230) or locking-plate fixation (n = 231). The baseline characteristics of the 2 groups were well balanced for age, sex, preinjury function, and intra-articular extension. The majority of injuries were A2, A3, C1, and C2 fractures. More than 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPRWE scores did not differ between the 2 groups at 12 months when assessed for the overall population (95% CI, \u22124.5 to 1.8; \u003Cem\u003EP\u003C\/em\u003E = .40; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) or according to age \u0026gt; 50 years or fracture (intra- vs extra-articular extension). Outcomes on the secondary measures were also similar. There was no difference in the number or type of complications between the groups, and there were negligible differences in quality-adjusted life-year gains.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EFive patients in the K-wire group and 2 in the plate group required revision surgery due to loss of fracture reduction. Nine patients in the plate group required removal of symptomatic metalwork (4 for screw penetration of the joint). A buried K-wire was surgically removed in 1 patient.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/41\/12\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Patient-Rated Wrist Evaluation Scores Over Time\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-295849422\u0022 data-figure-caption=\u0022Patient-Rated Wrist Evaluation Scores Over Time\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/41\/12\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/41\/12\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/41\/12\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15115\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPatient-Rated Wrist Evaluation Scores Over Time\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EPRWE, Patient-Rated Wrist Evaluation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EAdapted from BMJ, Percutaneous fixation with Kirschner wires vs volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomized controlled trial. Costa ML et al. 2014;349:g4807 \u00a9 2014 with permission from BMJ Publishing Group Ltd.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThe health economics results indicated that K-wires are less expensive and require significantly less operating time (median difference, 31 minutes; 95% CI, 28 to 35 minutes; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001). Therefore, Prof Gray recommended the use of K-wires vs volar locking plates for patients who are able to undergo a closed procedure to repair a dorsally displaced fracture of the distal radius.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/41\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzolc2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzolc2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}