Title: Distal Radius Internal Fixation Trial (DRIFT)
Funder: Department of Health (England)

Abstract: Background Distal radius fractures are a common problem that can result in permanent impairment and pain. Most of these fractures occur from a fall onto an outstretched hand among older women due to associated osteoporotic changes. Fractures are treated surgically if they are unstable and difficult to retain in a corrected position by means of reduction and a cast. Various surgical procedures exist but a lack of robust evidence makes it difficult to select the best option. In recent years internal fixation using plate and screws has become popular but the hardware is more expensive (up to £750) than simpler methods such as percutaneous “K” wires (£10-£20). However, internal fixation may be cost-effective if it results in a quicker return of function with less pain, and fewer complications. Aims The study aims to assess the benefits to patients and value for money of internal fixation of low-impact distal radius fractures using plate and screws compared to K wiring. The following null hypotheses will be tested: low-impact distal radius fractures treated operatively by internal fixation using plates and screws when compared to low-impact distal radius fractures treated operatively with K wiring offers (1) no significant benefit in terms of patients’ functional outcome at 3, 6 & 12 months; (2) no significant cost-benefits for the NHS and from a societal perspective (e.g. the associated costs of patients/carers taking time off work, and personal costs to patients) up to 12 months follow-up. The two groups will also be compared qualitatively from a patient perspective. Plan of Investigation A randomised controlled trial will be implemented at an orthopaedic NHS hospital and at three additional hospitals to recruit 144 patients over 18 months. Participants with low-impact distal radius fractures will be randomised to one of two surgical procedures. The primary outcome will be a functional score 3 months after injury assessed by patients using a validated questionnaire. Patient diaries will be used to gain a qualitative insight. The EQ5D will be used to measure health status and utility. The two procedures will be evaluated for their costs and benefits to patients over a 12-month period. Key costs will be staff time; time in theatre; equipment; time off work and personal costs to participants. A cost per unit of effect (based on wrist function or utility) will be determined. Potential Impact Distal radius fractures account for up to one-sixth of all fractures. Patients experience pain and loss of function for at least two months, or considerably longer if complications occur. The evidence of effectiveness of commonly applied interventions is inadequate according to several Cochrane reviews (Handoll 2003). Better treatment may improve patients’ ability to live independently both in the long and short-term. Surgically these fractures are not a small cost to the NHS, and their frequency and patient burden increases this cost. This study seeks to quantify such costs to the NHS and the patient. By comparing the clinical benefits and cost-effectiveness of two common surgical procedures it could improve treatment decision making to the potential benefit of many patients and the NHS.


Research activity codes: 6.4 SURGERY
Health categories: INJURIES AND ACCIDENTS