Surgical Fixation of Broken Wrists No Better Than Casting

Using metal K-wires to stabilize fractures of the distal radius is not superior to a traditional molded plaster cast, according to a new study.

Researchers at the University of Oxford (United Kingdom), John Radcliffe Hospital (Oxford, UK), the University of Leicester (United Kingdom), and other institutions conducted a study in 36 hospitals in the UK National Health Service (NHS) involving 500 adult patients with a dorsally displaced fracture of the distal radius to assess wrist function, quality of life, and subsequent complications. The patients were treated with either a molded plaster cast (255 patients) or surgical fixation with K-wires (245 patients).

Mean age of participants was 60 years, and 83% were women. The results indicated no statistically significant difference in patient rated wrist evaluation (PRWE) score was seen at 12 months, or at earlier time points. In the plaster cast group, 13% required surgical fixation for loss of fracture position in the first six weeks, compared with only one revision surgery in the K-wire group. Other complications were rare, with no evidence of a difference between the two groups. The study was published on January 19, 2022, in The BMJ.

“Surgical fixation with K-wires did not provide better wrist function at 12 months compared with a molded cast, indicating that a cast is an acceptable first line treatment following manipulation of dorsally displaced fracture of the distal radius,” concluded lead author professor of orthopedic trauma Matthew Costa, MD, and colleagues. “However, careful follow-up is needed as one in eight patients treated with a cast required subsequent surgical intervention, as the fracture reduction could not be maintained.”

Distal radius fractures occur when the section of the radius bone closest to the wrist is broken; the wrist may also be deformed, and the ulna may also be broken. Diagnosis is generally suspected based on symptoms and confirmed with X-rays. Treatment is with casting for six weeks or surgery, generally indicated if the joint surface does not line up, the radius is overly short, or the joint surface of the radius is tilted more than 10% backwards.

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University of Oxford
John Radcliffe Hospital
University of Leicester