Open reduction and internal fixation (ORIF) has been standardized as a routine surgical technique; at the same time, percutaneous K-wire fixation is becoming a common method for unstable distal radius fractures in older adults in China. Moreover, it is becoming increasingly popular because of its advantages of minimal invasion and low cost. Our orthopedic team achieved good clinical results by improving the percutaneous K-wire fixation technique to provide better support and anti-rotation. This study aimed to compare the clinical outcomes of improved percutaneous K-wire fixation and ORIF for the treatment of older patients with unstable distal radial fractures.

Electronic medical records of 60 consecutive unstable Colles fractures patients who underwent surgery from June 2019 to October 2021, by modified percutaneous K-wire fixation (30 patients) or ORIF (30 patients), were reviewed retrospectively. All cases were followed up for 3 months. The outcomes of patients were assessed with perioperative data included operation time, intraoperative blood loss, total hospitalization costs, and length of hospital stay. PT, RI, and RH were measured by collecting radiographs preoperatively and at 1 d, 4 weeks, and 8 weeks postoperatively. The degree of wrist pain was assessed using the VAS preoperatively and at 1, 3, and 7 days postoperatively. The Gartland-Werley scale was used to evaluate wrist joint functional outcomes at 3 months postoperatively; result evaluation: excellent 0–2 points, good 3–8 points, fair 9–20 points, poor > 21 points. Subjective patient satisfaction and postoperative complications were assessed using a questionnaire at the 3-month postoperative follow-up.General patient information included age, sex, and bone mineral density (BMD) T-score were also collected.Independent Student's t-test or Mann-Whitney U test were used to compare continuous data.Pearson's chi-square test or Fisher's exact test were used to analyze the categorical data.

The operation time and intraoperative blood loss were significantly shorter in the K-wire group than in the ORIF group (P < 0.05). Compared with the ORIF group, the VAS of the K-wire group was significantly lower at 1 and 3 days postoperatively (P<0.05), and no significant differences were observed in VAS between the two groups preoperatively and 7 days postoperatively (P>0.05). There were no significant differences in the PT, RI, and RH between the two groups preoperatively and at 1, 4, and 8 weeks postoperatively (P > 0.05). Patients in the K-wire group had significantly shorter hospital stays and lower total hospital costs (P < 0.05). All patients were followed up for 3 months, and there was no significant difference in the Gartland-Werley score between the two groups (P>0.05). Compared with the ORIF group, postoperative complications were lower, and patient subjective satisfaction was higher in the K-wire group, but there were no significant differences (P >0.05).

Both techniques have good clinical outcomes in the treatment of unstable distal radius fractures in the older population. However, improved percutaneous K-wire fixation has the advantages of a shorter operation time, reduced blood loss, reduced early postoperative pain, lower total hospitalization costs, shorter hospital stays, fewer postoperative complications, and higher subjective patient satisfaction. This is more easily accepted by older patients.