DRAFFT

Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial

Costa ML, Achten J, Parsons NR, et al. BMJ (Clinical research ed.) 2014 · PMID 25096595 · doi:10.1136/bmj.g4807

Question

For adults with a dorsally displaced distal radius fracture needing surgery, is volar locking plate fixation better than Kirschner wire fixation?

Design

Multicentre assessor-blinded RCT in 18 UK trauma centres.

Patients

Adults with a dorsally displaced distal radius fracture within 3 cm of the radiocarpal joint needing surgical fixation, excluding those whose joint surface needed open reduction.

Intervention

Open reduction and volar locking plate fixation

Comparison

Closed reduction and percutaneous Kirschner wire fixation

Primary outcome

Patient-Rated Wrist Evaluation (PRWE) at 12 months

Key result

There was no clinically relevant or statistically significant difference in PRWE at 3, 6 or 12 months, nor in quality of life or complication numbers.

Limitations

Fractures with intra-articular displacement that could not be reduced closed were excluded, so findings do not cover complex articular fractures.

Impact on practice

K-wire fixation is a reasonable, cost-effective first option for dorsally displaced extra-articular or simple intra-articular fractures that can be reduced closed, and is reflected in BOAST guidance.