scholarly journals UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

2015 ◽  
Vol 19 (17) ◽  
pp. 1-124 ◽  
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Caroline Plant ◽  
Nick R Parsons ◽  
Amar Rangan ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Health Technology ◽  
Kirschner Wires ◽  
Locking Plate Fixation ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Displaced Fracture

BackgroundIn high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation.MethodsIn this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation©(PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness.ResultsThe baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: –1.3; 95% confidence interval (CI) –4.5 to 1.8;p = 0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI –0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (–£727; 95% CI –£588 to –£865), particularly in younger patients.ConclusionsContrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced fractures of the distal radius. A Kirschner-wire fixation is less expensive and quicker to perform.Trial registrationCurrent Controlled Trials ISRCTN31379280.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 17. See the NIHR Journals Library website for further project information.

scholarly journals Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: five-year follow-up of a randomized controlled trial

2019 ◽  
Vol 101-B (8) ◽  
pp. 978-983 ◽  
Author(s):  
M. L. Costa ◽  
J. Achten ◽  
A. Rangan ◽  
S. E. Lamb ◽  
N. R. Parsons
Keyword(s):  
Quality Of Life ◽  
Distal Radius ◽  
Locking Plate ◽  
Controlled Trial ◽  
Plate Fixation ◽  
Locking Plate Fixation ◽  
Plate Group ◽  
Displaced Fracture

Aims The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. Patients and Methods We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture. Results At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group). Conclusion This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: Bone Joint J 2019;101-B:978–983.

scholarly journals Clinical and Functional Outcome of Volar Locking Plate Fixation for Distal Radius Fracture

2009 ◽  
Vol 58 (2) ◽  
pp. 283-286 ◽  
Author(s):  
Shoichi Kuba ◽  
Itaru Furuichi ◽  
Masakazu Murata ◽  
Takeshi Miyaji ◽  
Noriaki Miyata ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Radius Fracture ◽  
Volar Locking Plate ◽  
Locking Plate Fixation

scholarly journals A prospective study of distal radius fracture management by close reduction, percutaneous Kirschner wire fixation and plaster immobilization

2017 ◽  
Vol 3 (3) ◽  
pp. 537
Author(s):  
Abhishek Chattopadhyay ◽  
Upal Banerjee ◽  
Prashant Kumar Sinha ◽  
Subarna Misra ◽  
Ananya Chattopadhyay ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Excellent Result ◽  
Kirschner Wire ◽  
Radius Fracture ◽  
Invasive Technique ◽  
Fair Result ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Plaster Immobilization

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal radius fracture is one of the most common fractures. It may be sustained due to low-energy trauma or high-energy trauma. Objectives: To compare the clinical effectiveness of Kirschner wire fixation with and plaster immobilization for patients with fracture of the distal radius.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. About 79 patients with Distal Radial Fractures presented to MGM Medical College and LSK Hospital, Kishanganj between November 2012 and June 2014 were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The majority were men (60.4%). Majority of the patients (69.8%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. In our study, according to AO classification, 31 cases were of Type A, 17 were of Type B and 5 were of Type C. The Anatomical evaluation by Sarmiento’s Criteria showed 33 patients with excellent result, 15 patients with good result and 5 with a fair result. At final follow-up by ‘The Gartland and Werley criteria for functional outcome’ 37 patients had excellent result, 13 had good result, 2 had fair result and 1 had a poor result. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This study demonstrates that percutaneous Kirschner<strong> </strong>wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical<strong> </strong>fracture reduction. It does not required highly skilled<strong> </strong>personnel or sophisticated tools for application. It is a<strong> </strong>suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.</span></p>

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