Abstract
Background Distal radius fractures are a common orthopaedic injury with several treatment methods.
This systematic review and meta-analysis aims to synthesize the results of the latest
randomized controlled trials (RCTs) and compare the functional outcomes and rates
of complications in Kirschner's wire (K-wire) fixation versus cast immobilization
in the management of distal radius fractures.
Materials and Methods A systematic electronic search of Embase, PubMed, and Scopus was performed from inception
through to July 26, 2024. All articles addressing RCTs comparing plaster cast immobilization
and K-wire fixation in distal radius fractures were included. This study was performed
according to the Preferred Items for Systematic Reviews and Meta-Analysis guidelines.
The quality of studies was assessed using the Cochrane Risk-of-Bias 2 tool for RCTs.
Results A total of nine studies with 1,097 patients (580 and 517 who underwent cast immobilization
and K-wire fixation, respectively) were included for analysis. There was a significantly
higher risk of complications (risk ratio [RR]: 1.75, 95% confidence interval [CI]:
1.10–2.78; p = 0.02) and malunion (RR: 9.03, 95% CI: 2.57–31.75; p = 0.0006) in cast immobilization than K-wiring. There was also a significant difference
in Patient-Rated Wrist Evaluation (PRWE) scores at 12 months (mean difference: 0.81;
95% CI: 0.10–1.52; p = 0.02). There were no significant differences in other outcomes that could be meta-analyzed
such as range of motion and grip strength. There was also no significant difference
in other complications such as chronic regional pain syndrome, finger stiffness, and
osteoarthritis.
Conclusion This systematic review and meta-analysis found a significantly higher risk of total
adverse events and malunion in cast immobilization than K-wiring as well as a significant
difference in PRWE scores at 12 months. Our results thus suggest that K-wiring is
more favorable than cast immobilization in the management of distal radius fractures.
Keywords
distal radius fracture - wrist fracture - percutaneous pinning - plaster cast - Kirschner's
wires
