Evidence map›Paper›PMID 35152940›Full record

Trial reportHealth technology assessment (Winchester, England)2022

Moulded cast compared with K-wire fixation after manipulation of an acute dorsally displaced distal radius fracture: the DRAFFT 2 RCT.

Matthew L Costa, Juul Achten, Alexander Ooms, May Ee Png, Jonathan Cook, Melina Dritsaki, Sarah E Lamb, Robin Lerner, Kylea Draper, Marta Campolier and 6 more

Open access · diamondAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Health technology assessment (Winchester, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
2.4field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 7 institutions in 1 country.

Matthew L CostaOxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-3644-1388
Juul AchtenOxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-8857-5743
Alexander OomsCentre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-1877-8323
May Ee PngNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0001-5876-9363
Jonathan CookCentre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-4156-6989
Melina DritsakiCentre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-1673-3036
Sarah E LambOxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-4349-7195
Robin LernerOxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-8372-8181
Kylea DraperOxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0001-6900-6134
Marta CampolierOxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-7168-2534
Helen DakinNuffield Department of Population Health, University of Oxford, Oxford, UK.ORCID 0000-0003-3255-748X
Alwin McGibbonPatient and public involvement group member, Wimbourne, UK.ORCID 0000-0002-5116-9063
Nicholas ParsonsStatistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.ORCID 0000-0001-9975-888X
Helen HedleyDepartment of Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.ORCID 0000-0001-5324-9019
Joseph DiasAToMS Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.ORCID 0000-0001-5360-4543
DRAFFT 2 Collaborators
Nuffield Orthopaedic Centre · GBUniversity of Oxford · GBQueen Mary University of London · GBUniversity Hospitals Coventry and Warwickshire NHS Trust · GBUniversity Hospitals of Leicester NHS Trust · GBUniversity of Exeter · GBUniversity of Warwick · GB

Funding

Department of Health
6 · The paper itself

Abstract

backgroundPatients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking.

objectiveTo compare functional outcomes, quality-of-life outcomes, complications and resource use among patients with a dorsally displaced fracture of the distal radius treated with manipulation and surgical fixation with Kirschner wires (K-wires) and those treated with manipulation and moulded cast.

designPragmatic, superiority, multicentre, randomised controlled trial with a health economic evaluation.

settingA total of 36 orthopaedic trauma centres in the UK NHS.

participantsPatients (aged ≥ 16 years) treated for an acute dorsally displaced fracture of the distal radius were potentially eligible. Patients were excluded if their injury had occurred > 2 weeks previously, if the fracture was open, if it extended > 3 cm from the radiocarpal joint or if it required open reduction, or if the participant was unable to complete questionnaires.

interventionsParticipants were randomly assigned in theatre (1 : 1) to receive a moulded cast (i.e. the cast group) or surgical fixation with K-wires (i.e. the K-wire group) after fracture manipulation.

main outcome measuresThe primary outcome measure was the Patient-Rated Wrist Evaluation score at 12 months, analysed on an intention-to-treat basis. Health-related quality of life was recorded using the EuroQol-5 Dimensions, five-level version, and resource use was recorded from a health and personal social care perspective.

resultsBetween January 2017 and March 2019, 500 participants (mean age 60 years, 83% women) were randomly allocated to receive a moulded cast ( LIMITATIONS: Because the interventions were identifiable, neither patients nor clinicians could be blind to their treatment.

conclusionsSurgical fixation with K-wires was not found to be superior to moulded casting following manipulation of a dorsally displaced fracture of the distal radius, as measured by Patient-Rated Wrist Evaluation score. However, one in eight participants treated in a moulded cast required surgery for loss of fracture reduction in the first 6 weeks. After a successful closed reduction, clinicians may consider a moulded cast as a safe and cost-effective alternative to surgical fixation with K-wires. FUTURE WORK: Further research should focus on optimal techniques for immobilisation and manipulation of this type of fracture, including optimal analgesia, and for rehabilitation of the patient after immobilisation.

trial registrationThis trial is registered as ISRCTN11980540 and UKCRN Portfolio 208830.

fundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in

Indexed as

Bone WiresRadius FracturesAdolescentCost-Benefit AnalysisFemaleHumansMaleMiddle AgedQuality of LifeSurveys and QuestionnairesBONECOST–BENEFIT ANALYSISDISTAL RADIUSFRACTURESK-WIRE FIXATIONMOULDED CASTORTHOPAEDIC TRAUMAQUALITY OF LIFERANDOMISED CLINICAL TRIALTECHNOLOGY ASSESSMENTWRIST FUNCTION

Identifiers

PMID35152940
PMCPMC8883335
OpenAlexW4212790586

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.