Abstract

Aim
To determine whether moulded casting provides outcomes comparable to K-wire fixation for dorsally displaced distal radius fractures in adults.

Method
Systematic searches of PubMed, OVID, Cochrane Library, and Scopus identified 1,053 studies. Twenty studies met the inclusion criteria (6 RCTs, 14 observational). Data extracted included study design, participant demographics, intervention type, and outcomes such as functional scores, pain, grip strength, quality of life (QoL), and complications. Pooled analyses were conducted using random-effects models, and the GRADE framework was used to assess the certainty of evidence.

Results
Across long-term follow-up, casting produced equivalent functional outcomes to K-wire fixation (SMD = +0.25, 95% CI –0.31–0.82; high-certainty). Pain outcomes highlighted no meaningful difference, with an immediate postoperative SMD of +0.01 (95% CI –0.16–0.19) and a mid-term SMD of –0.02 (95% CI –0.19–0.14). Grip strength (SMD = –0.23) and complication rates (RR = 1.02) were also comparable. K-wire fixation showed only a short-term functional advantage (≤3 months) (SMD = +1.27), which did not persist beyond early recovery. Importantly, quality of life favoured immediate postoperative casting (SMD = –0.33, p < 0.05), with no differences thereafter. GRADE assessment indicated high certainty for equivalent long-term function, mid-term pain, and complication rates.

Conclusions
Although K-wire fixation offers faster early recovery, moulded casting delivers equivalent long-term outcomes, similar pain and complication rates, and better early QoL. These findings strongly support casting as an effective, low-risk, and resource-efficient first-line treatment for dorsally displaced distal radius fractures in adults.