title: Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial.
abstract: OBJECTIVE
  To compare the clinical effectiveness of Kirschner wire fixation with locking plate fixation for patients with a dorsally displaced fracture of the distal radius.
  
  
  METHODS
  A multicentre two arm parallel group assessor blind randomised controlled trial with 1:1 treatment allocation.
  
  
  METHODS
  18 trauma centres in the United Kingdom.
  
  
  METHODS
  461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation. Patients were excluded if the surgeon thought that the surface of the wrist joint was so badly displaced it required open reduction.
  
  
  METHODS
  Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. Locking plate fixation: a locking plate is applied through an incision over the volar (palm) aspect of the wrist and secured to the bone with fixed angle locking screws.
  
  
  METHODS
  
  
  
  METHODS
  validated patient rated wrist evaluation (PRWE). This rates wrist function in two (equally weighted) sections concerning the patient's experience of pain and disability to give a score out of 100.
  
  
  RESULTS
  disabilities of arm, shoulder, and hand (DASH) score, the EuroQol (EQ-5D), and complications related to the surgery.
  
  
  RESULTS
  The baseline characteristics of the two groups were well balanced, and over 90% of patients completed follow-up. The wrist function of both groups of patients improved by 12 months. There was no clinically relevant difference in the patient rated wrist score at three, six, or 12 months (difference in favour of the plate group was -1.3, 95% confidence interval -4.5 to 1.8; P=0.40). Nor was there a clinically relevant difference in health related quality of life or the number of complications in each group.
  
  
  CONCLUSIONS
  Contrary to the existing literature, and against the rapidly increasing use of locking plate fixation, this trial found no difference in functional outcome in patients with dorsally displaced fractures of the distal radius treated with Kirschner wires or volar locking plates. Kirschner wire fixation, however, is cheaper and quicker to perform.
  
  
  BACKGROUND
  Current Controlled Trials ISCRTN 31379280. UKCRN 8956.
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK Matthew.costa@warwick.ac.uk.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Costa
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
authors.forename: Juul
authors.initials: J
authors.lastname: Achten
authors.affiliation: Clinical Sciences Research Laboratories, University of Warwick, Coventry CV2 2DX, UK.
authors.forename: Nick R
authors.initials: NR
authors.lastname: Parsons
authors.affiliation: Wolfson Research Institute, School of Medicine and Health, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK.
authors.forename: Amar
authors.initials: A
authors.lastname: Rangan
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
authors.forename: Damian
authors.initials: D
authors.lastname: Griffin
authors.affiliation: Leeds Institute of Health Sciences, Leeds University, Leeds LS2 9LJ, UK.
authors.forename: Sandy
authors.initials: S
authors.lastname: Tubeuf
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7HE, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001860:Bone Plates; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
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