We read “Surgical fixation with K-wires versus casting in adults with ­fracture of distal radius: DRAFFT2 multicentre randomised clinical trial” with great interest. In this study, Manipulation and moulded cast was compared with manipulation and surgical fixation with K-wires plus cast.[1] The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months (five questions about pain and 10 about function and disability. The results show that no statistically significant difference in the PRWE score was seen at 12 months. Finally, the authors concluded that among patients with a dorsally displaced distal radius fracture that needed manipulation, surgical fixation with K-wires did not improve patients’ wrist function at 12 months compared with a cast. We really appreciate this achievement that the authors have made. As readers, we have some questions or suggestions that we hope the authors could take into consideration.

In this study, the majority of cases are female, with an average age of 60.1 years, at which most people are accompanied by osteoporosis. Osteoporosis was not described in this study. For patients with osteoporosis, internal fixation with K-wires may be unreliable.

From the index of reduction loss rate, the K-wire group is significantly better than the cast group, and there are statistical differences, indicating that in the fixed reliability, the K-wire group is still better than the cast group, and this result still shows that the K-wire fixation has a certain effect. As for no difference in function, it may be too short in the follow-up period, and the patient's tolerance, subjective degree and other factors, may not necessarily reflect the difference.

In some cases, the fractures are involving the joint surface. Does the K-wire fix the bone block of the joint surface specifically after the reduction? This should also be described.

There was a loss of 13% reduction in the cast group, indicating that the vast majority of cases in the control group was stable after reduction, which has little clinical significance for the comparison. That is to say, the selected cases should be judged whether stable after reduction, if unstable, whether fixed with a K-wire. If it is stable after the reductiont, it is not meaningful to compare whether to add K-wires. The following conditions are unstable after reduction: the dorsal fracture obvious displacement, obvious loss of palm inclination, the dorsal comminuted fracture, combined with ulna fracture, and age more than 60 with osteoporosis. In the majority of the author's cases, fracture reduction of the cases was not lost, so stability fracture should account for the majority of cases. More significance should be made to compare the two treatments for unstable fractures.

1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China. Address: No 639, Zhizaoju Road, Shanghai, 200011, China. Email: yubaofu2008@126.com

2 Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China. Address: No 1665, Kongjiang Road, Shanghai, 200092, China Email: shenhao@xinhuamed.com.cn

References: 1. Costa ML, Achten J, Ooms A, et al. Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial. BMJ. 2022;376:e068041.

Competing interests: No competing interests