Functional outcome of closed reduction and cast application verses closed reduction and percutaneous k-wire fixation for distal end of radius fractures

Introduction: Fracture of the distal radius is the most common fracture. Mal-union of the distal radius has been associated with pain, stiffness, weak grip strength and carpal instability even after the fracture has healed. There are multiple treatment options in the treatment of distal radius fractures, including closed reduction and cast immobilization, percutaneous K-wire fixation (kapandji intra-focal pinning, trans-radial styloid pinning, pinning via the Lister’s tubercle or trans-ulnar pinning), fixation with volar or dorsal plates (locking or non-locking), bridge plating, use of an external fixator by means of ligamentotaxis to realign fracture displacement. Still there are treatment controverses as there is no single definitive modality which is considered the standard of care. Material and Method: This randomized prospective comparative study had 56 patients with fractures of distal radius (Frykman type I-VIII) were included in the study. All the patients were randomly divided into two groups. In the group A, patients were treated by closed reduction percutaneous K-wire application with below elbow slab application, while in the group B, patients were treated by closed reduction and below elbow cast application. All the patients were followed up and functionally evaluated by the demerit scoring system of Gartland and Werley (1951) at 6 weeks, 12 weeks and 6 months. Results: Out of 56 patients in this study, 30 patients were females and 26 were males. Mean age with standard deviation of group A and group B was 40.66±16.72 and 48.81±14.65 respectively. In group A and group B, fracture distribution according to FRYKMAN classification, type I-II fracture was 33.3% and 54.5% and type VII-VIII fracture was 17.9% and 4.5 % respectively. 36 had intra-articular fracture and the remaining 20 patients had extra-articular fracture. According to Gartland and Werley demerit scoring, at 6 month follow up, 40%+48.6% patients had excellent and good results in group A as compared to 47.6%+38.1% patients in group B. Comparable number of patients had deformity in both the groups i.e 12 in group A and 10 in group B. Finger stiffness was found in 3 patients in group A and 2 patients in group B. In group A 11 patients had arthrithis as compared to group B had 15 patients. Median nerve compression was found in 1 patient in each group. Conclusion: Closed reduction and k-wire stabilization is marginally superior to closed reduction and Cast application in terms of final functional outcomes. CR and casting can be an easy, non-invasive and safe option to treat fractures of distal radius if patients are carefully chosen.