Wrist fractures are common, especially in older women. If the bone fragments have displaced (moved out of their normal alignment), they often require "manipulation" followed either by surgery to insert metal wires or plates, or a moulded cast as a non-surgical alternative, to hold the bones in position while they heal.
Surgery is expensive and carries risk for the patient, whereas a moulded plaster cast is cheaper but may not provide the same functional outcome.
To find out which of these treatments is superior, NDORMS researchers tracked the progress of 500 adults with a displaced wrist fracture at 36 NHS hospitals between January 2017 and March 2019. The results are published today in the BMJ.
The DRAFFT2 study randomly allocated patients to receive a cast (255) or surgical fixation with K-wires (245) after manipulation of their fracture. Their average age was 60 years and 417 (83%) were women.
The main (primary) outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months, which included questions about pain, function and disability, and gave an overall score from 0 (best) to 100 (worst).
Other (secondary) outcomes were PRWE score at three and six months, quality of life, and complications, including the need for later surgery.