Function Versus Position: A Randomized Controlled Trial of Interfocal Kirschner Wiring of Unstable Distal Radial Fractures.

Introduction: A randomized, prospective study has been carried out to determine if immobilisation in dorsiflexion following K-wire fixation of unstable distal radial fractures improves functional outcome.

Methods: Sixty patients with unstable fractures of the distal radius were entered into the trial. There were 52 female and 11 male with an average age of 60yrs (17-84). Randomisation was undertaken in theatre using a closed envelope system. The fractures were initially reduced by closed manipulation and interfocal percutaneous K-wires inserted. Patients randomised to group I had their wrists placed in 30 degrees of dorsiflexion and group II had their wrists placed in 30 degrees of palmer flexion. Patients were reviewed with an x-ray at 1, 3, 5, and 17 weeks by a single physician. Dorsal angulation, Radial inclination, Radial length and Radial height were measured. The K-wires were removed in the outpatient clinic at 3 weeks and the plaster at 5 weeks. Blinded functional review was carried out by an Occupational therapist at 5, 8 and 17 weeks post operation. The power and pinch grip was measured using a Jamar dynamometer. Flexion and extension were measured with a goniometer.

Results: There was no statistical difference in radiological or functional outcomes in either group. At 17 weeks the mean dorsal angulation was -0.5 and -1.9 degrees. The mean radial shortening was 1.5mm in both groups. The power grip was 86% and 82% and pinch grip was 99% and 101%. Patients regained 76% and 79% of flexion and 94% and 88% of extension compared to the opposite side.

Conclusions: Immobilisation in dorsi-flexion following K-wiring for unstable distal radial fractures does not improve functional outcome. The overall functional results were excellent and we believe that Kwiring still as a place in the treatment of distal radial fractures in the previously defined population.