Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2022;10(4):14 BMJ. 2022 Jan 19:376:e068041.What this means for my practice?
In dorsally displaced distal radius fractures amenable to closed reduction, casting and K-wire fixation result in similar patient reported wrist function at 1 year postoperatively. Casting results in higher rates of further surgery and loss of fracture reduction. Future trials involving comparing nonoperative management to contemporary operative strategies is warranted.
Study Summary
Five hundred adult patients with dorsally displaced distal radius fractures amenable to closed reduction were randomized to receive K-wire fixation (n=245) or moulded cast (n=255). The primary outcome was wrist function as measured by the Patient Rated Wrist Evaluation (PRWE) at 12 month follow-up. Secondary outcomes included quality of life, complications and the need for further surgery. There was no significant difference in PRWE scores or quality of life at any time point postoperatively. The moulded cast group had significantly higher rates of loss of fracture reduction at 6 weeks and need for further surgery within a year of the injury.
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