Comparison of Kirschner wire versus volar locking plate fixation for distal radius fractures: clinical and functional outcomes

Objective: This study aimed to compare the clinical and functional outcomes of Kirschner wire (K-wire) fixation versus volar locking plate (VLP) fixation for intra-articular distal radius fractures (DRFs). It also aimed to identify key patient- and fracture-related factors that influence the choice of surgical technique and to evaluate the responsiveness of specific patient-reported outcome measures in assessing recovery. Methods: A total of 201 consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association–classified DRFs (Type A: n = 51; B: n = 90; C: n = 60) treated surgically between 2005 and 2022 were analyzed. Treatment allocation was based on fracture complexity and surgeon preference, resulting in a distribution where K-wire (n = 63) was primarily used for partial articular fractures (72.4% of K-wire cases were Type B), while VLP (n = 138) was preferred for complete articular fractures (83.6% of plate cases were Type C). Functional outcomes were assessed using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) (primary endpoint), Green-O’Brien, Gartland–Werley, and SF-12 at standardized intervals (6/12/24 months) during supervised physiotherapy. Results: Significant predictors of plate fixation included older age (58.1 ± 14.7 vs. 42.3 ± 12.1 years, P < .001), polytrauma (aOR: 2.4, 95% CI: 1.5-3.8), and complete articular fractures (83.6% Type C, P = .01). No statistically significant associations were found between injury type and fixation method (P = .20) or between complications and fixation method (4.8% vs. 2.2%, P = .41). Functional outcomes were comparable across all metrics, with no statistically significant differences observed: QuickDASH (34.9 ± 18.2 K-wire vs. 31.2 ± 16.8 plate, P = .146), Green-O’Brien (excellent-good: 76.2% vs. 82.6%, P = .552), Gartland–Werley (78.1% vs. 71.1% excellent-good, P = .591), and 12-Item Short Form Health Survey (SF-12) (100% vs. 99.3% good results, P = .32). Multivariable regression identified reduction quality (β = 0.81, P < .01), not implant type, as the primary outcome determinant. Conclusion: This study suggests that anatomical reduction quality—not fixation method—is the primary determinant of functional success in DRFs, with both K-wire and VLP achieving comparable outcomes (QuickDASH/Gartland–Werley P > .05). K-wires represent a cost-effective alternative for partial articular fractures (72.4% of cases), while plates were more frequently used in complex fractures and polytrauma cases (adjusted odds ratio [aOR] = 2.4). Early rehabilitation (median 4 days post-op) and condition-specific metrics (QuickDASH, Green-O’Brien) are critical for optimal recovery, whereas SF-12 proves less sensitive for wrist-specific assessment. These findings advocate for surgeon-tailored technique selection based on fracture pattern and emphasize the need for multicenter randomized controlled trials (RCTs) to evaluate long-term outcomes. Cite this article as: Yigit O, Kart H, Cat G, et al. Comparison of Kirschner wire versus volar locking plate fixation for distal radius fractures: clinical and functional outcomes. Acta Orthop Traumatol Turc. 2026; 60(2), 0585, doi: 10.5152/j.aott.2026.25585.