The Wrist and Radius Injury Surgical Trial (WRIST): 12-month outcomes from a multicenter, international randomized clinical trial
Kevin C. Chung, MD, MS, H. Myra Kim, PhD, Sunitha Malay, MPH, Melissa Shauver, MPH, WRIST Group, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: To compare patient-reported and functional outcomes after surgical treatment or casting in patients age 60 years or older with unstable distal radius fractures (DRFs).
Methods: The Wrist and Radius Injury Surgical Trial (WRIST), a pragmatic, randomized, multicenter trial, enrolled 304 adults with isolated, unstable DRFs at 24 institutions. Patients who preferred surgical treatment (n=187) were randomized to internal fixation with volar plate (VLPS), external fixation (EFP), or percutaneous pinning (CRPP); patients who preferred conservative management (n=117) received casting. The primary outcome was 12-month Michigan Hand Outcomes Questionnaire (MHQ) Summary score.
Results: At 12 months, there were no differences in primary or secondary outcomes by treatment. MHQ Summary scores differed between VLPS and EFP by 2.7 points (97.5%CL:-6.0,11.5) and between VLPS and CRPP by -0.14 (-9.2,8.9). (Figure1) However, 6-week mean MHQ Summary score for VLPS participants was greater than EFP by 19.1 (p<0.001), CRPP by 10.7 (p<0.001) and casting by 7 (p=0.03). VLPS participants also demonstrated significantly better radiologic alignment and maintained alignment through the follow-up period, though there was no relationship between outcomes and alignment. Pin site infections were experienced by 28% of EFP and 19% of CRPP participants.
Conclusion: Recovery was fastest for VLPS and slowest for EFP participants according to most measures, but by 12 months there were no differences in outcomes. Casting participants experienced satisfactory results despite loss of radiologic alignment.
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