Fractures of the distal radius are extremely common injuries. However, optimal management of fractures of the distal radius and adults remains controversial. In general if the bone fragments are undisplaced i.e. the bone fragments remain in anatomical alignment, fractures of the distal radius are treated non-operatively. However, if the bone fragments have displaced i.e. moved out of their normal alignment, then the treating clinician will usually recommend a "manipulation" of the bone fragments to restore the normal anatomy. Manipulating a fracture is painful, therefore this is carried out using either local, regional or general anesthetic.
Following the manipulation, the bone fragments can fall back out of normal alignment. Therefore the treating clinician will apply support to the bone fragments while they heal.
This trial will compare two techniques for holding the position of the bone fragments following a manipulation of a dorsally displaced fracture of the distal radius.
The first technique involves the application of a plaster cast which is shaped (molded) over the skin to hold the bone fragments in position. This technique is simple and quick to perform, there is little risk of complications and the materials used are cheap. However, the plaster cast is not applied directly to the bone and fragments therefore it is possible for the bone fragments to re-displace under the cast - particularly when the swelling starts to settle a few days after the surgery.
The second technique involves the surgical fixation of the bone fragments using Kirschner wires (K-wires). During this procedure smooth metal wires with a sharp point are passed through the skin across the fracture site to hold the bone fragments in position while they heal. A plaster cast is applied over the top of the wires to hold the wrist joint still, but the cast does not have to be molded into position as the wires themselves hold the bone in place. K-wire fixation therefore reduces the risk of re-displacement of the fracture. However, there are small risks from the surgery including infection and damage to the nerves or blood vessels around the wrist; K-wire fixation also takes longer than applying a plaster cast and the wires and theater consumables cost can.
The primary objective is:
1. To quantify and draw inferences on observed differences in the Patient Rated Wrist Evaluation (a validated assessment of wrist function) between surgical fixation with K-wires versus plaster casting in the first year after surgery.
The secondary objectives are:
1. To quantify and draw inferences on observed differences in the EQ-5D-5L (a validated assessment of Health-related Quality of Life) between the trial treatment groups in the year post-surgery.
2. To quantify and draw inferences between the trial treatment groups on observed differences in the routine radiographic images of the wrist taken up to 6 weeks after surgery.
3. To determine the complication rate, including the need for further surgery, of surgical fixation with K-wires versus casting at one year post-surgery.
4. To investigate, using appropriate statistical and economic analysis methods, the healthcare resource use, and comparative cost effectiveness at one year, of surgical fixation with K-wires versus plaster casting.