Kirschner's Wire versus Casts in Wrist Fractures: A Systematic Review and Meta-analysis.

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.