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AIMS: The aim of this study was to compare the cost-effectiveness of surgical fixation with Kirschner (K-)wire ersus moulded casting after manipulation of a fracture of the distal radius in an operating theatre setting. METHODS: An economic evaluation was conducted based on data collected from the Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT2) multicentre randomized controlled trial in the UK. Resource use was collected at three, six, and 12 months post-randomization using trial case report forms and participant-completed questionnaires. Cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY) gained from an NHS and personal social services perspective. Sensitivity analyses were conducted to examine the robustness of cost-effectiveness estimates, and decision uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves. RESULTS: In the base case analysis, surgical fixation with K-wire was more expensive (£29.65 (95% confidence interval (CI) -94.85 to 154.15)) and generated lower QALYs (0.007 (95% CI -0.03 to 0.016)) than moulded casting, but this difference was not statistically significant. The probability of K-wire being cost-effective at a £20,000 per QALY cost-effectiveness threshold was 24%. The cost-effectiveness results remained robust in the sensitivity analyses. CONCLUSION: The findings suggest that surgical fixation with K-wire is unlikely to be a cost-effective alternative to a moulded cast in adults, following manipulation of a fracture of the distal radius in a theatre setting.Cite this article: Bone Joint J 2022;104-B(11):1225-1233.

Original publication




Journal article


Bone Joint J

Publication Date





1225 - 1233


Cast, Cost, Distal Radius Acute Fracture Fixation Trial 2, Distal radius, EQ-5D-5L, Effectiveness, Fracture, K-wire, K-wire fixation, Kirschner (K-)wire, Trial, extension of fracture, fractures of the distal radius, multicentre randomized controlled trial, plaster cast, surgical fixation, t-tests, Adult, Humans, Bone Wires, Cost-Benefit Analysis, Radius, Bone Plates, Fracture Fixation, Internal, Fractures, Bone, Radius Fractures, Fracture Fixation