K-wire shows striking advantages to plateosteosynthesis for distal metaphyseal radius fracture in children: a retrospective, two-center study

BACKGROUND: Metaphyseal distal radius fractures are very common in children. Even though there is a return toward successful conservative treatment, there are still distal radius fractures that require surgical treatment. K-wire osteosynthesis has become the most common surgical procedure. But no gold standard has been defined yet and evidence directly comparing pin and plate fixation in pediatric patients remains limited. Some hospitals prefer plate osteosynthesis for metaphyseal fractures in especially older children. Aim of the study was to compare complications, operative time, radiation exposure, reduction quality, and functional outcomes of K-wire versus plate osteosynthesis in pediatric metaphyseal distal radius fractures. METHODS: We retrospectively analyzed children aged 2-15 years treated for metaphyseal distal radius fractures between 2010 and 2022 at two Level I trauma centers. Demographic, radiographic, and surgical data were extracted from hospital records. Postoperative alignment was measured on early radiographs, and complications were graded using the modified Clavien-Dindo-Sink classification. Secondary outcomes included reduction quality, operative and fluoroscopy times, hospital stay, immobilization, and range of motion. RESULTS: , p < 0.0001), and hospitalization (1.8 (1.5) vs. 2.4 (1.6) days; p < 0.0001) shorter, but longer immobilization (4 (0.7) vs. 1.9 (1.7) weeks; p < 0.0001). Plate fixation achieved superior reduction (92% vs. 67%, p < 0.0001). Secondary displacement occurred in 3% of K-wire cases, all single-wire constructs; 27% of those with secondary dislocation required revision. No pseudarthroses were observed in both groups. CONCLUSIONS: K-wire osteosynthesis offers a safe, efficient, and minimally invasive option with fewer complications, shorter recovery and shorter radiation exposure time. Plate fixation provides better reduction but higher morbidity and longer surgery, and should be reserved for irreducible fractures or older children with little remodeling potential. However, both methods achieved reliable healing and full functional recovery.