A randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a displaced fracture of the distal radius
A broken wrist is being mended with metal wires or a metal plate, and a trial is tracking which method gives patients a better recovery a year later. This matters because fractures of the distal radius are among the most common broken bones in adults, yet surgeons lack clear evidence on which of two widely used operations—K-wire fixation or volar locking-plate fixation—produces better long-term function. Both techniques are standard within the NHS, but no large, randomised comparison has settled the question. If the trial finds one method clearly superior, surgeons could adopt it as the preferred approach, reducing recovery time, complications, and the need for follow-up procedures. For patients, that could mean a faster return to everyday tasks such as writing, lifting, or dressing. For the NHS, it could mean fewer follow-up appointments and less variation in surgical practice across centres. The study is a direct clinical comparison with immediate practical implications. It does not explore fundamental mechanisms of bone healing, but its results could change how thousands of wrist fractures are treated each year.
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The aim of this study is to determine if there a difference in the Patients Rated Wrist Evaluation (PRWE) one year post-injury between adult patients with a dorsally displaced fracture of the distal radius treated with volar locking-plate fixation versus K-wire fixation. This trial will be recruiting 390 patients from 10 centres across the UK. All adult patients presenting with an acute fracture of the distal radius which requires surgical fixation are potentially eligible to take part in the trial. Prior to surgery, the research associate will collect baseline demographic data, radiographs and pre-injury functional data using the PRWE and the Disabilities of Arm, Shoulder and Hand score (DASH). The patients will also be asked to fill out the EuroQol quality of life questionnaire to indicate both their injured and pre-injury health status. A randomisation sequence at a ratio of 1:1, stratified by centre, intra-articular extension of the fracture and age of the patient (above or below 50 years), will be produced and administered independently. Each patient will be randomly allocated to either wire fixation or locking-plate fixation. Both of these operations are widely used within the NHS and all of the surgeons will be familiar with both techniques. The research associate will perform a clinical assessment and make a record of any early complications at 6 weeks. Post-operative radiographs will also be taken at 6 weeks and 12 months. The functional outcome data will be collected using the PRWE and DASH questionnaires at 3 months, 6 months and 12 months post-operatively. In addition, patients will be asked to fill out the EuroQol questionnaire and a resource use questionnaire and provide details of any late complications or interventions related to their injury. These postal questionnaires will be administered centrally by a research assistant blind to the treatment allocation.
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