gms | German Medical Science

Objectives/Interrogation: There are several options for the operative treatment of distal radial fractures, but the two most-common forms of surgical fixation are percutaneous K-wire and locking-plate fixation. Although the latter technique has attracted increasing popularity in recent years, the former is still useful for selected fractures. The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation.

Methods: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n=363) or palmar-plate (n=104) fixation. The results were assessed at 3 and 12 months by the same outcome measures.

Results and Conclusions: No statistically significant differences were observed in any of the analysed variables: range of wrist motion, total grip strength, and DASH scores at the final assessment. Statistically significant differences were noted in radiological measures of the palmar tilt (0O vs -5O) and the ulnar variance (0.3 vs 1.4 mm), both favouring the plate-fixation method. Although K-wire fixation provides suboptimal stability and does not guarantee the maintaining of the reduction, it can be effective for selected fracture configurations, which constitute at least 2/3 of their total number. We concluded that being guided by the postulated algorithm in the choice of treatment for distal radial fractures struck a reasonable balance between clinical- and cost-effectiveness.