Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial. (19th January 2022)

• Record Type: Journal Article
• Authors: Costa, Matthew L; Achten, Juul; Ooms, Alexander; Png, May Ee; Cook, Jonathan A; Lamb, Sarah E; Hedley, Helen; Dias, Joseph
• Other Names: author non-byline.; Dritsaki Melina author non-byline.; Dakin Helen author non-byline.; Jones Jonathan author non-byline.; Mckee Andrew author non-byline.; Smith Kevin author non-byline.; Hamadto Mohamed author non-byline.; Gwilym Steve author non-byline.; Chesser Tim author non-byline.; Candal-Couto Jaime author non-byline.; Hing Caroline author non-byline.; Giddin David author non-byline.; Johnston Phil author non-byline.; Ullah Aamer author non-byline.; Williams John author non-byline.; Eardley Will author non-byline.; Srinivasan Makaram author non-byline.; Sampalli Sridharrao author non-byline.; Farrar Mark author non-byline.; Roberts Chris author non-byline.; Mohanty Khitish author non-byline.; MacLeod Iain author non-byline.; Sarda Praveen author non-byline.; Elseehy Amr author non-byline.; Rossiter Nigel author non-byline.; Warwick David author non-byline.; Peach Chris author non-byline.; MacKay David author non-byline.; Benson Richard author non-byline.; Watts Adam author non-byline.; Young Jonathan author non-byline.; Shah Feisal author non-byline.; Lipscombe Stephen author non-byline.; Ng Aaron author non-byline.; Charalambous Bambos author non-byline.; Sheriden Barnaby author non-byline.; Theivendran Kanthan author non-byline.; Sanjay Pulimamidi author non-byline.; Nanda Rajesh author non-byline.; Bateman Antony author non-byline.; Butler Michael author non-byline.; Keast-Butler Oliver author non-byline.; McAndrew Andrew author non-byline.; Chevannes Wystan author non-byline.; Kankanalu Pradeep author non-byline.; Wijendra Asanka author non-byline.; Fontalis Andreas author non-byline.; Afifi Hytham author non-byline.; Killen Marie-Clare author non-byline.; Higgin Ryan author non-byline.; Wignadasan Warran author non-byline.; Wong Ken author non-byline.; Gibson Catherine author non-byline.; Beale Harry author non-byline.; Jennings Bob author non-byline.; Kennedy James author non-byline.; Williamson Mark author non-byline.; Rasidovic Damir author non-byline.; Jenner Lydia author non-byline.; Tadros John Baha author non-byline.; Milner Steve author non-byline.; Duncan James author non-byline.; Kerr Sally author non-byline.; Nordin Louise author non-byline.; Weston Matt author non-byline.; Payton Olivia author non-byline.; Oni Tofi author non-byline.; Zhao Craig author non-byline.; Gill Sukhdeep author non-byline.; Iqbal Mohammad author non-byline.; Killen Marie-Clare author non-byline.; Aneiba Khaled author non-byline.; Wignadasan Warran author non-byline.; Pillai Dilip author non-byline.; Hughes Luke author non-byline.; Crosby Jonathan author non-byline.; Whitehouse Mike author non-byline.; Corbett Thomas author non-byline.; Iqbal Arshad author non-byline.; Buchan Steph author non-byline.; Beddard Laura author non-byline.; Vardhan Venkat author non-byline.; Beamish Becky author non-byline.; Jones Matt author non-byline.; Holley Jonathan author non-byline.; Morrell Rebecca author non-byline.; Lerner Robin author non-byline.; Draper Kylea author non-byline.;
• Is Part Of: BMJ. Volume 376(2022)
• Publication Date: 2022-01-19
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj-2021-068041
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To assess wrist function, quality of life, and complications in adult patients with a dorsally displaced fracture of the distal radius, treated with either a moulded cast or surgical fixation with K-wires. Design: Multicentre randomised clinical superiority trial, Setting: 36 hospitals in the UK National Health Service (NHS). Participants: 500 adults aged 16 or over with a dorsally displaced fracture of the distal radius, randomised after manipulation of their fracture (255 to moulded cast; 245 to surgical fixation). Interventions: Manipulation and moulded cast was compared with manipulation and surgical fixation with K-wires plus cast. Details of the application of the cast and the insertion of the K-wires were at the discretion of the treating surgeon, according to their normal clinical practice. Main outcome measures: The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months (five questions about pain and 10 about function and disability; overall score out of 100 (best score=0 and worst score=100)). Secondary outcomes were PRWE score at three and six months, quality of life, and complications, including the need for surgery due to loss of fracture position in the first six weeks. Results: The mean age of participants was 60 years and 417 (83%) were women; 395 (79%) completed follow-up. No statistically significant difference in the PRWE score was seen at 12 months (cast group (n=200), mean 21.2 (SD 23.1); K-wire group (n=195), mean 20.7 (22.3); adjusted mean difference −0.34 (95% confidence interval −4.33 to 3.66), P=0.87). No difference was seen at earlier time points. In the cast group, 33 (13%) of participants needed surgical fixation for loss of fracture position in the first six weeks compared with one revision surgery in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10). Conclusions: Among patients with a dorsally displaced distal radius fracture that needed manipulation, surgical fixation with K-wires did not improve patients' wrist function at 12 months compared with a cast. Trial registration: ISRCTN registry ISRCTN11980540 .