Andrew 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].

Surgical 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 [ISRCTN31379280] 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 < 2 weeks old and the surgeon believed that the patient would benefit from fracture fixation. Patients with fractures extending > 3 cm from the radiocarpal joint and those with an open fracture with a Gustillo grade > 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).

The 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.

PRWE scores did not differ between the 2 groups at 12 months when assessed for the overall population (95% CI, −4.5 to 1.8; P = .40; Figure 1) or according to age > 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.

Five 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.

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Figure 1.

Patient-Rated Wrist Evaluation Scores Over Time

PRWE, Patient-Rated Wrist Evaluation.Adapted 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 © 2014 with permission from BMJ Publishing Group Ltd.

The 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; P < .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.

• © 2014 MD Conference Express®