Kirschner's Wire versus Casts in Wrist Fractures: A Systematic Review and Meta-analysis.

Background: Distal radius fractures are a common orthopaedic injury with several treatment methods. This systematic review and meta-analysis aims to synthesize the results of the latest randomized controlled trials (RCTs) and compare the functional outcomes and rates of complications in Kirschner's wire (K-wire) fixation versus cast immobilization in the management of distal radius fractures. Materials and Methods: A systematic electronic search of Embase, PubMed, and Scopus was performed from inception through to July 26, 2024. All articles addressing RCTs comparing plaster cast immobilization and K-wire fixation in distal radius fractures were included. This study was performed according to the Preferred Items for Systematic Reviews and Meta-Analysis guidelines. The quality of studies was assessed using the Cochrane Risk-of-Bias 2 tool for RCTs. Results: A total of nine studies with 1,097 patients (580 and 517 who underwent cast immobilization and K-wire fixation, respectively) were included for analysis. There was a significantly higher risk of complications (risk ratio [RR]: 1.75, 95% confidence interval [CI]: 1.10-2.78; p  = 0.02) and malunion (RR: 9.03, 95% CI: 2.57-31.75; p  = 0.0006) in cast immobilization than K-wiring. There was also a significant difference in Patient-Rated Wrist Evaluation (PRWE) scores at 12 months (mean difference: 0.81; 95% CI: 0.10-1.52; p  = 0.02). There were no significant differences in other outcomes that could be meta-analyzed such as range of motion and grip strength. There was also no significant difference in other complications such as chronic regional pain syndrome, finger stiffness, and osteoarthritis. Conclusion: This systematic review and meta-analysis found a significantly higher risk of total adverse events and malunion in cast immobilization than K-wiring as well as a significant difference in PRWE scores at 12 months. Our results thus suggest that K-wiring is more favorable than cast immobilization in the management of distal radius fractures.