This study by McLauchlan and colleagues compares the results of casting alone with those of casting and supplemental percutaneous K-wire fixation to maintain reduction of metaphyseal fractures of the distal radius in children. The study design is commendable even though it was not possible to blind the treating physicians or to adjust for technical variations after the treatment was selected. Previously reported surgical complications of wire fixation in the setting of this injury include pin-track infections, physeal closure, and neuropraxia 1,2 . These rare complications were not likely to have been observed in such a small study. Despite these limitations, more randomized trials such as this one should be encouraged.
Although this study is a valuable addition to our knowledge base, it does not completely answer the fundamental question of whether these fractures should or should not be pinned at the time of initial reduction. The duration of follow-up was short and only addressed the immediate concerns regarding maintenance of reduction during the treatment period. Three months after injury, the clinical outcome in the K-wire group was the same as that in the group treated with casting alone. In the latter group, remanipulation was more frequent, some patients had residual angulation within acceptable limits for this age-group, and one required a corrective osteotomy. However, the patients in the K-wire group also had some complications, including pin migration requiring surgical retrieval, and two of the patients had unsightly scars.
This study suggests that the current trend toward fixation of completely displaced fractures of the distal radius in children is safe and reliable. However, it also confirms that traditional closed management with remanipulation as required can also produce satisfactory results.