Analysis of functional outcome for unstable distal radius fractures treated with closed reduction and percutaneous ‘K’ wire fixation with casting and closed reduction with casting: A comparative study

BACKGROUND: Fractures of the distal radius are among the most common fractures and closed in most of the cases, has long been treated by closed reduction with casting. Although cast does provide support, it may fail to maintain the reduction. Percutaneous ‘K’ Wire fixation is a simple way of providing additional stability to immobilization in cast in an unstable fracture of distal radius in which anatomical reduction is obtainable. OBJECTIVE: The purpose of present study was to compare two treatment methodologies (1) Closed reduction along with percutaneous K wire fixation with casting. (2) Closed reduction and casting alone for the treatment of displaced unstable extra-articular and simple intra-articular fractures of distal part of radius, with specific emphasis on functional and radiological outcome. MATERIALS AND METHODS: A prospective randomised study was performed at Govt. Stanley Medical College and Hospital, Chennai. Forty patients with displaced, unstable fractures of distal radius were randomised in two treatment groups Closed reduction along with percutaneous K wire fixation with casting (n=20) or Closed reduction and casting alone (n=20). Functional and radiological assessments were done at six, nine, twelve weeks post-intervention. Outcome was measured on the basis of range of motion, grip strength, Disability of Arm, Shoulder and Hand (DASH) Scoring, radiological parameters. Detailed analysis of complications was performed. RESULTS: On functional analysis based upon Disability of Arm, Shoulder and Hand (DASH) scoring system the K wire fixation and casting group had lower mean scores compared with closed reduction and casting group both at nine (16.59 compared with 18.41 with p value 0.593) and at twelve weeks (17.24 compared with 17.76 with p value 0.877) indicating no significant difference in terms of functional outcome; though lower scores indicates better outcome considered on individual basis. At end of twelfth week post-intervention thirteen patients (76.87%) of K wire and casting group resumed to their regular work as compared to ten (58.82%) patients of closed reduction and casting group. On radiological assessment both group of patients had significant improvement in radiological criteria viz; Radial Length, Volar tilt, Radial Inclination and Ulnar variance post-intervention (with p values for each of parameters