DRAFFT is a UK multicenter RCT comparing K-wire versus volar locking-plate fixation for dorsally displaced distal radius fractures requiring surgery. This five-year follow-up answers whether early equivalence persisted — and whether patients developed late arthritis or required salvage surgery. 448 adults from 18 trauma centers were followed with the PRWE as the primary outcome.
For years, volar locking plates dominated distal radius fixation in part because of superior radiographic reduction — the assumption being that better X-rays meant better outcomes. The original DRAFFT trial challenged this at one year, and critics argued that late arthritis would eventually tip the balance toward plates.
This five-year data closes that argument. When you see a dorsally displaced distal radius fracture — even with intra-articular extension — that requires surgical fixation but not open reduction, K-wire fixation is a fully defensible choice. The functional outcomes are identical, reoperation is rare in both groups, and the cost-effectiveness data favor wires.
The practical implication: use the technique you execute well. This paper is why the UK shifted practice away from routine locking-plate use after 2014, and why cost-conscious systems worldwide have followed.
One nuance worth knowing: radiological outcomes (alignment, reduction quality) favored plates in prior literature, yet this did not translate into functional benefit — reinforcing that PRWE and patient-reported function, not X-ray parameters, are the correct endpoints for judging distal radius fixation.
DRAFFT is a UK multicenter RCT comparing K-wire versus volar locking-plate fixation for dorsally displaced distal radius fractures requiring surgery. This five-year follow-up answers whether early equivalence persisted — and whether patients developed late arthritis or required salvage surgery. 448 adults from 18 trauma centers were followed with the PRWE as the primary outcome.
For years, volar locking plates dominated distal radius fixation in part because of superior radiographic reduction — the assumption being that better X-rays meant better outcomes. The original DRAFFT trial challenged this at one year, and critics argued that late arthritis would eventually tip the balance toward plates.
This five-year data closes that argument. When you see a dorsally displaced distal radius fracture — even with intra-articular extension — that requires surgical fixation but not open reduction, K-wire fixation is a fully defensible choice. The functional outcomes are identical, reoperation is rare in both groups, and the cost-effectiveness data favor wires.
The practical implication: use the technique you execute well. This paper is why the UK shifted practice away from routine locking-plate use after 2014, and why cost-conscious systems worldwide have followed.
One nuance worth knowing: radiological outcomes (alignment, reduction quality) favored plates in prior literature, yet this did not translate into functional benefit — reinforcing that PRWE and patient-reported function, not X-ray parameters, are the correct endpoints for judging distal radius fixation.