Washington: A new study has found that the use of metal K-wires, commonly known as “pins”, to hold broken wrist bones in place while they heal is no better than a traditional cast plaster cast.
The study has been published in the ‘BMJ Journal’.
Wrist fractures are common, especially in older women. If the bone fragments are displaced (moved out of their normal alignment), they often require “manipulation” followed by either surgery to insert metal wires or plates, or a cast casting as a non-surgical alternative, to hold the bones in place while heler.
Surgery is expensive and involves risk for the patient, whereas a cast plaster cast is cheaper but may not give the same functional result.
To find out which of these treatments is superior, researchers tracked the progress of 500 adults with a staggered wrist fracture at 36 NHS hospitals between January 2017 and March 2019.
Patients were randomized to receive a cast (255) or K-threaded surgical fixation (245) after manipulation of their fracture. Their average age was 60 years and 417 (81 percent) were women.
The primary (primary) outcome measure was the Patient Rated Wrist Evaluation (PRWE) score after 12 months, which included questions about pain, function, and disability and gave an overall score from 0 (best) to 100 (worst).
Other (secondary) results were PRWE score after three and six months, quality of life and complications, including the need for later surgery.
A total of 395 (79 percent) patients completed the follow-up. While both groups showed improvement over the 12-month period, no statistically significant difference was seen in the PRWE score after three, six or 12 months (mean score 21.2 in the plaster group compared to 20.7 in the K-wire group ).
Health-related quality of life also showed a similar pattern of recovery in both groups over time, and again the difference was not significant.
However, one in eight patients treated with a cast cast later required surgery for loss of fracture position in the first six weeks after their injury compared with only one patient in the K-wire group.
Other complications were rare, with no evidence of difference between the two groups (28 in the plaster group compared with 22 in the K-wire group).
The researchers recognized some limitations, including the fact that neither the treating clinicians nor the participants could be blind to the interventions.
Nevertheless, they say this was a large trial involving adults of all ages, and the results are based on validated patient-reported results that reflect the care provided across a health care system.
As such, they concluded, “K-wire surgical fixation did not provide better wrist function after 12 months compared to a cast cast, indicating that a cast is an acceptable first-line treatment after manipulating a dorsally displaced fracture of the distal radius.”
They added: “Casting treatment avoids the cost and risks of surgical fixation for seven out of eight patients. However, careful follow-up is needed as one in eight patients treated with plaster required subsequent surgery as the fracture reduction could not be maintained.”