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Kirschner's Wire versus Casts in Wrist Fractures: A Systematic Review and Meta-analysis
Brandon Lim1, Stephanie Talbot2, Samher Jassim2
1Department of General Medicine, Changi General Hospital, Singapore.
Journal of Wrist Surgery
|November 21, 2025
Summary
Kirschner wire (K-wire) fixation shows better outcomes for distal radius fractures than cast immobilization. K-wiring reduces risks of complications and malunion, improving patient-rated wrist function.
Area of Science:
- Orthopaedic Surgery
- Evidence-Based Medicine
- Systematic Review and Meta-Analysis
Background:
- Distal radius fractures are common orthopaedic injuries with varied treatment options.
- Current management strategies include cast immobilization and Kirschner's wire (K-wire) fixation.
- Comparative effectiveness data on these treatments are crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs).
- To compare functional outcomes and complication rates between K-wire fixation and cast immobilization for distal radius fractures.
- To synthesize the latest evidence on treatment efficacy.
Main Methods:
- Systematic electronic search of Embase, PubMed, and Scopus databases.
- Inclusion of RCTs comparing cast immobilization and K-wire fixation.
- Quality assessment using the Cochrane Risk-of-Bias 2 tool.
Main Results:
- Nine studies with 1,097 patients were analyzed.
- Cast immobilization had a significantly higher risk of complications (RR: 1.75) and malunion (RR: 9.03).
- A significant difference favoring K-wiring was observed in Patient-Rated Wrist Evaluation (PRWE) scores at 12 months (MD: 0.81).
Conclusions:
- K-wire fixation is associated with a lower risk of adverse events and malunion compared to cast immobilization.
- K-wire fixation demonstrates superior patient-reported functional outcomes at 12 months.
- K-wiring appears to be a more favorable treatment option for distal radius fractures.
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