DRAFFT2

Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial

Costa ML, Achten J, Ooms A, et al. BMJ (Clinical research ed.) 2022 · PMID 35045969 · doi:10.1136/bmj-2021-068041

Question

After satisfactory closed reduction of a dorsally displaced distal radius fracture, does K-wire fixation give better outcomes than a moulded cast?

Design

Pragmatic multicentre RCT in UK NHS trauma units.

Patients

Adults with a dorsally displaced distal radius fracture that had been satisfactorily closed reduced in the emergency department.

Intervention

Surgical K-wire fixation

Comparison

Moulded plaster cast

Primary outcome

Patient-Rated Wrist Evaluation (PRWE) at 12 months

Key result

There was no significant difference in PRWE at 12 months between K-wires and casting, though a minority of cast patients later needed surgery for loss of position.

Limitations

Only included fractures with an acceptable closed reduction, and surgeons and patients were not blinded.

Impact on practice

Supports a well-moulded cast after good closed reduction rather than routine K-wiring, with close radiographic follow-up to identify redisplacement.