Distal radius fractures are among the most common fractures encountered in adults and frequently result from falls onto an outstretched hand. [1] These injuries may affect wrist function, grip strength, and the ability to perform routine activities. Extra-articular distal radius fractures, classified as AO/OTA type A, do not involve the radiocarpal joint but may still be associated with instability, displacement, and loss of reduction. Restoration of radial height, radial inclination, and volar tilt is essential for achieving satisfactory functional outcomes [2-4]. Conservative management with closed reduction and below-elbow cast immobilization remains a widely used treatment for extra-articular distal radius fractures. It avoids surgical risks and is suitable for fractures that are stable after reduction. However, unstable fractures may undergo secondary displacement during immobilization, leading to malunion, reduced wrist movement, and impaired function. Factors such as dorsal comminution, initial displacement, and associated instability may influence the likelihood of loss of reduction [5,6]. Closed reduction and percutaneous Kirschner wire (K-wire) fixation provide additional stabilization while preserving the biological environment of the fracture. This technique may help maintain fracture alignment during healing, although potential complications include pin-tract infection, wire migration, and the need for pin removal. Comparative studies have reported improved radiological maintenance with supplementary pinning, but functional advantages over cast treatment have not been consistently demonstrated [2,7]. The DRAFFT2 randomized controlled trial compared K-wire fixation with cast immobilization in adults with dorsally displaced distal radius fractures. It found no significant difference in patient-reported wrist function at 12 months, although patients managed with a cast were more likely to require subsequent surgery because of loss of fracture reduction [8]. Similarly, systematic reviews have reported that the choice of treatment should be individualized according to fracture stability, patient characteristics, and functional requirements rather than assuming universal superiority of one technique [9,10]. The present study aims to assess and compare the functional outcomes of extra-articular distal radius fractures in adults treated with closed reduction and internal fixation using percutaneous K-wires versus conservative management with closed reduction and below-elbow cast immobilization. Functional outcomes are evaluated using the Modified Green and O’Brien Score at 1, 3, and 6 months following treatment.

After obtaining approval from the Institutional Ethics Committee, the present comparative study was conducted in the Department of Orthopaedics at Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India. A total of 40 adult patients with extra-articular distal radius fractures were enrolled in the study. Eligible participants were aged above 18 years and fulfilled the predefined inclusion and exclusion criteria. Written informed consent was obtained from all participants prior to their enrolment. The confidentiality of all participants was maintained throughout the study. Group Allocation Patients were allocated into two treatment groups, with 20 patients in each group. • Group A: CRIF with K-wire fixation: This group consisted of 20 patients who underwent closed reduction and internal fixation using percutaneous K-wire fixation for stabilization of the extra-articular distal radius fracture. • Group B: Conservative management: This group consisted of 20 patients who underwent closed reduction followed by immobilization using a below-elbow cast. Inclusion Criteria The study included:  Adult patients aged above 18 years.  Patients with extra-articular distal radius fractures. Exclusion Criteria The following patients were excluded:  Patients with open distal radius fractures.  Patients with pathologies associated with neurovascular deficit of the affected upper limb.  Patients with other bone pathology.  Patients with multiple fractures or polytrauma involving the same limb. Treatment Protocol The participants were divided into two groups, with 20 patients in each group. Patients in Group A underwent closed reduction followed by percutaneous Kirschner wire (K-wire) fixation. The procedure was intended to maintain fracture reduction and provide stability during the healing period. Patients in Group B underwent closed reduction followed by below-elbow cast immobilization. The cast was used to maintain fracture reduction during the healing period. Radiological Assessment Radiographic evaluation was performed at presentation to assess the fracture pattern and displacement. Follow-up radiographs were obtained during the study period to evaluate fracture healing and maintenance of reduction. The anatomical parameters considered were radial height, radial inclination, and volar tilt. Functional Assessment Functional outcomes were assessed using the Modified Green and O’Brien Score, as modified by Cooney. The score evaluates pain, functional status, range of motion, and grip strength, with a maximum possible score of 100. Functional outcomes were classified as follows: Functional outcomes were assessed using the Modified Green and O’Brien Score, as modified by Cooney. The scoring system evaluates four parameters:  Pain  Functional status  Range of motion  Grip strength Each parameter contributes to the overall score, with a maximum possible score of 100. Figure 1: Modified Green and O’Brien Score Functional outcomes were categorized according to the Modified Green and O’Brien Score as excellent (90–100), good (80–89), fair (65–79), and poor<65. The score was used to evaluate functional recovery following treatment and to compare outcomes between the two groups. Follow-up Patients were followed up at the following intervals:  1 month  3 months  6 months At each follow-up, patients were assessed for radiological healing, wrist range of motion, complications, and functional recovery. The final functional outcome was evaluated at 6 months. Statistical Analysis The data were analyzed using appropriate statistical methods. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The normality of continuous data was assessed using the Shapiro–Wilk test. Between-group comparisons of normally distributed continuous variables were performed using the independent-samples Student’s t-test, while the Mann–Whitney U test was used for non-normally distributed data. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Changes in functional scores over time were evaluated using repeated-measures analysis of variance (ANOVA) for normally distributed data or the Friedman test for non-normally distributed data. A p-value of less than 0.05 was considered statistically significant.

Demographic Characteristics: A total of 40 adult patients with extra-articular distal radius fractures were included in the study. The mean age of the study population was 44.8 ± 12.6 years. Of the 40 patients, 28 (70%) were females and 12 (30%) were males. The largest proportion of patients belonged to the 31–50-year age group, accounting for 45% of the study population. Patients aged 18–30 years and 51–70 years each constituted 25%, while 5% of patients were older than 70 years. Table 1. Demographic Characteristics of the Study Population Characteristic Category Number of patients (n=40) Percentage Age 18–30 years 10 25% 31–50 years 18 45% 51–70 years 10 25% >70 years 2 5% Gender Female 28 70% Male 12 30% Total 40 100% Functional Outcomes: Functional outcomes were assessed using the Modified Green and O’Brien Score at 1, 3, and 6 months following treatment. Both groups demonstrated progressive improvement in functional scores during the follow-up period. However, the mean functional scores were consistently higher in the group treated with percutaneous K-wire fixation than in the group treated with below-elbow cast immobilization. At 1 month, the mean functional score was 62.3 ± 6.8 in the K-wire fixation group compared with 48.6 ± 7.4 in the cast immobilization group. At 3 months, the respective scores were 78.9 ± 7.2 and 63.2 ± 8.1. At the final follow-up of 6 months, the mean score increased to 87.6 ± 6.2 in the K-wire fixation group and 74.2 ± 8.9 in the cast immobilization group. [Table 2, Figure 2] Table 2. Comparison of Mean Functional Scores at Follow-Up Follow-up Group A: K-wire fixation (n=20) Group B: Cast immobilization (n=20) 1 month 62.3 ± 6.8 48.6 ± 7.4 3 months 78.9 ± 7.2 63.2 ± 8.1 6 months 87.6 ± 6.2 74.2 ± 8.9 Figure 2: Comparison of Mean Functional Scores at Follow-Up Functional Outcome Categories at Six Months: At the final follow-up, excellent outcomes were observed in 10 (50%) patients in the K-wire fixation group and four (20%) patients in the cast immobilization group. Good outcomes were recorded in seven (35%) patients in Group A and eight (40%) patients in Group B. Fair outcomes were observed in three (15%) patients in the K-wire fixation group and six (30%) patients in the cast group. No patient in Group A had a poor outcome, whereas two (10%) patients in Group B were classified as having poor outcomes. Overall, 17 (85%) patients in the K-wire fixation group achieved excellent or good functional outcomes, compared with 12 (60%) patients in the cast immobilization group. [Table 3, Figure 3] Table 3. Functional Outcome Categories at Six Months Functional outcome Group A: K-wire fixation (n=20) Group B: Cast immobilization (n=20) Excellent 10 (50%) 4 (20%) Good 7 (35%) 8 (40%) Fair 3 (15%) 6 (30%) Poor 0 (0%) 2 (10%) Excellent or good 17 (85%) 12 (60%) Figure 3: Functional Outcome Categories at Six Months Figure 4: Serial radiographs of an extra-articular distal radius fracture showing pre-reduction, post-reduction, and follow-up appearances at 1, 3, and 6 months. Figure 5. Serial radiographs of an extra-articular distal radius fracture treated with percutaneous K-wire fixation, showing preoperative, postoperative, and follow-up appearances at 1, 3, and 6 months.

The present study compared the functional outcomes of extra-articular distal radius fractures treated with closed reduction and internal fixation (CRIF) using percutaneous K-wire fixation and conservative management with closed reduction and cast immobilization. A total of 40 adult patients were included, with 20 patients in each group. Functional outcomes were assessed using the Modified Green and O’Brien Score at 1, 3, and 6 months. The principal finding was that patients treated with K-wire fixation demonstrated higher functional scores throughout the follow-up period, indicating a more favorable pattern of functional recovery. At the final follow-up of 6 months, the mean functional score was 87.6 ± 6.2 in the K-wire group compared with 74.2 ± 8.9 in the conservative group. The difference of 13.4 points indicates a clinically notable advantage in the K-wire group. This difference was also evident during the early and intermediate phases of recovery. At 1 month, the mean score was 62.3 ± 6.8 in the K-wire group and 48.6 ± 7.4 in the conservative group. At 3 months, the corresponding scores were 78.9 ± 7.2 and 63.2 ± 8.1, respectively. The consistently higher scores suggest that the functional advantage associated with K-wire fixation was maintained during the study period. The findings are consistent with the clinical relevance of the comparative study conducted by Venkatesh et al., who evaluated closed reduction and cast application against percutaneous K-wire fixation for extra-articular distal radius fractures [11]. Their work addressed the role of operative stabilization in this specific fracture subgroup. Although differences in study populations and assessment methods should be considered, the present findings similarly suggest that K-wire fixation may be beneficial in appropriately selected patients, particularly when fracture stability is a concern. The potential functional advantage of K-wire fixation may be related to its ability to maintain fracture reduction during healing. Extra-articular distal radius fractures, particularly displaced or unstable fractures, may lose reduction following closed manipulation. Secondary displacement can alter radial height, radial inclination, and volar tilt, potentially affecting wrist biomechanics and subsequent function. Percutaneous K-wire fixation provides additional stabilization after reduction and may help maintain alignment during the healing period. Its minimally invasive nature also permits stabilization without extensive soft-tissue dissection. However, the present study did not provide numerical radiological measurements; therefore, the contribution of anatomical maintenance to the observed functional differences cannot be quantitatively established. The distribution of functional outcomes at 6 months further supports the observed pattern. Excellent outcomes were recorded in 10 patients (50%) in the K-wire group compared with 4 patients (20%) in the conservative group. Good outcomes were observed in 7 patients (35%) and 8 patients (40%), respectively. Fair outcomes were reported in 3 patients (15%) in the K-wire group and 6 patients (30%) in the conservative group. Poor outcomes were observed in 2 patients (10%) in the conservative group, while none were reported in the K-wire group. Overall, 17 patients (85%) in the K-wire group achieved excellent or good outcomes, compared with 12 patients (60%) in the conservative group. This distribution suggests a greater proportion of favorable functional outcomes following K-wire fixation, although statistical significance cannot be inferred from these descriptive results alone. Previous studies have explored the role of wire-based stabilization in distal radius fractures. Walton and Brammar described the treatment of unstable distal radius fractures using intrafocal and intramedullary K-wires, highlighting the application of wire fixation in maintaining fracture stability [12]. Kurup and Madalia examined variables affecting the stability of distal radius fractures fixed with K-wires through radiological assessment, emphasizing the importance of fracture characteristics and fixation technique in maintaining reduction [13]. Hashmi and Rafi described a modified Kapandji wiring technique for unstable distal radius fractures, demonstrating the relevance of percutaneous wiring approaches that limit surgical exposure while providing fracture stabilization [14]. These studies provide a clinical context for the use of K-wire fixation; however, differences in fracture patterns, fixation methods, and outcome measures should be considered when comparing their findings with the present study. Patil et al. also compared closed reduction and cast application with percutaneous K-wire fixation in extra-articular distal radius fractures [15]. Their work further supports the relevance of evaluating these two treatment modalities within this fracture subgroup. Nevertheless, the present study’s results should be interpreted in relation to its own sample size, follow-up duration, and available outcome data rather than assuming direct equivalence with findings from other studies. An important observation was the progressive improvement in functional scores in both groups. In the conservative group, the mean score increased from 48.6 ± 7.4 at 1 month to 74.2 ± 8.9 at 6 months. In the K-wire group, it increased from 62.3 ± 6.8 to 87.6 ± 6.2. This improvement reflects the gradual recovery of wrist function following fracture treatment. Fracture healing, reduction in pain, restoration of range of motion, and improvement in grip strength are important components of functional recovery. The improvement observed in the conservative group indicates that closed reduction and cast immobilization can also provide functional recovery in selected patients. Conservative management remains a reasonable option for minimally displaced and stable fractures. It avoids surgical intervention and may be appropriate for patients with contraindications to surgery. However, secondary displacement and the effects of prolonged immobilization should be considered during treatment selection. The findings of the present study support considering CRIF with K-wire fixation in appropriately selected adults with extra-articular distal radius fractures, particularly when maintaining reduction is a clinical concern. The results do not establish that operative treatment is preferable for every fracture, and treatment decisions should account for fracture stability, patient characteristics, and clinical requirements. The findings should be interpreted cautiously. The study included only 40 patients and had a follow-up period of 6 months. Furthermore, numerical radiological measurements and inferential statistical results were not available. Therefore, the observed differences in functional scores and outcome categories are descriptive and cannot be considered statistically significant based on the information provided. The study was limited by its small sample size of 40 patients and single-centre design, restricting generalizability. Follow-up was limited to 6 months, preventing assessment of long-term outcomes. Radiological measurements and inferential statistical results were unavailable, limiting evaluation of anatomical restoration and statistical significance.

The present study highlights the potential functional benefits of CRIF with percutaneous K-wire fixation over conservative management in adults with extra-articular distal radius fractures. Patients treated with K-wire fixation demonstrated a more favorable pattern of functional recovery throughout the follow-up period, with a greater proportion achieving excellent outcomes and fewer experiencing poor functional results. These findings suggest that K-wire fixation may be a valuable treatment option when fracture instability or maintenance of reduction is a clinical concern. Nevertheless, conservative management remains appropriate for stable and minimally displaced fractures, emphasizing the importance of individualized treatment selection. Ultimately, the choice of management should be guided by fracture characteristics, stability, patient-related factors, and functional demands. Further well-designed studies with larger populations, extended follow-up, and comprehensive radiological and statistical assessment are warranted to strengthen the evidence regarding the comparative effectiveness of these treatment approaches.

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