Comparative evaluation of radiological and functional outcomes in extra-articular distal radius fractures managed by closed reduction with cast versus percutaneous K-wire fixation

Background: Distal radius fractures are among the most common fractures encountered in orthopaedic practice, accounting for approximately one-sixth of all skeletal fractures. Although closed reduction with casting remains the standard treatment for stable extra-articular fractures, maintenance of reduction remains a challenge in unstable fracture patterns. Percutaneous Kirschner wire (K-wire) fixation has been advocated as a minimally invasive technique to improve fracture stability and prevent secondary displacement. The present study was undertaken to compare the radiological and functional outcomes of closed reduction with cast immobilization and closed reduction with percutaneous K-wire fixation followed by cast immobilization in patients with extra-articular distal radius fractures. Methods: A prospective randomized controlled study was conducted in the Department of Orthopaedics, GMERS Medical College and Civil Hospital, Morbi, from July 2025 to July 2026. One hundred adult patients with AO type 23-A2 and 23-A3 extra-articular distal radius fractures were randomly allocated into two equal groups. Group A underwent closed reduction and below-elbow cast application, whereas Group B underwent closed reduction with percutaneous K-wire fixation followed by below-elbow casting. Radiological parameters including radial height, radial inclination, volar tilt and ulnar variance, along with functional outcomes using the Gartland and Werley demerit scoring system, were assessed. Statistical analysis was performed using SPSS version 29, with p <0.05 considered statistically significant. Results: Patients treated with percutaneous K-wire fixation demonstrated significantly better maintenance of radial height, radial inclination, volar tilt and ulnar variance than patients treated with casting alone (p<0.05). Functional outcomes at final follow-up were comparable between the two groups despite superior radiological restoration in the K-wire fixation group. Conclusions: Closed reduction with percutaneous K-wire fixation provides superior maintenance of anatomical alignment compared with closed reduction and cast immobilization alone while achieving comparable short-term functional outcomes. The technique is simple, minimally invasive, economical and particularly useful in unstable extra-articular distal radius fractures.