[A comparison of the results of the conservative vs operative by percutaneous Kirschner-wiring treatment of fractures of the distal radius]

Abstract

The objective of this study was comparing the results of the conservative (close reduction and immobilisation in the plaster splint) vs operative (percutaneous Kirschner-wiring) treatment of fractures of the distal radius. Sixty patients, 49 women (82%) and 11 men (18%), who sustained an isolated, displaced fractures were randomly allocated to operative (30 patients) or conservative (30 patients) treatment. All patients were followed up at 1.5, 3 and finally at 6 months after fracture. The following variables were analysed: rate of secondary displacement, wrist range of motion, fingers loss of flexion, total grip strength, dorsal or volar tilt, radial angulation and radial length on the X-ray. Function of the hand was assessed with DASH questionnaire, cold sensitivity with McCabe scale and final outcome in Gartland-Werley and Castaing complex scales. The rate of secondary displacement was considered a primary outcome measure.

Results: Secondary displacement was noted in 8 patients (27%) treated conservatively, of whom 7 required surgery and those were withdrawn from the trial. Three fractures (10%) treated operatively displaced secondarily, but none required additional operation and all completed the follow-up. The rate of secondary displacement was statistically significantly (chi2 test, p < 0.05) more frequent in conservatively treated group. With regard to other analysed parameters, the statistically significant differences was found in total grip strength at 3 and 6 months assessments, and in DASH score at 6 months assessment, both favouring operative method. The remaining variables did not differ significantly between the groups treated conservatively and operatively.

Conclusion: Our results have demonstrated, that percutaneous Kirschner-wiring of fractures of the distal radius is superior to the conservative treatment, because statistically significantly reduces the risk of secondary displacement and allows to obtain a stronger grip and better hand function within 6 months after fracture.