Abstract
AIMS: Distal radius metaphyseal-diaphyseal transition zone fractures in children are challenging due to their distinct anatomical features and slower healing speed. Although both percutaneous long Kirschner wire (K-wire) intramedullary fixation and open reduction with plate and screw fixation are commonly employed, there is no clear consensus on the optimal surgical strategies. This study aimed to compare the clinical outcomes of percutaneous long K-wire intramedullary fixation and open reduction with plate and screw fixation. METHODS: We conducted an analysis of pediatric patients aged 8-14 years treated for distal radius metaphyseal-diaphyseal transition fractures between August 2021 and July 2023. Patients were stratified into two cohorts: the Long K-wire group, treated via closed reduction and percutaneous intramedullary fixation targeting the radial medullary isthmus, and the Plate group, treated via open reduction and internal fixation (ORIF). Perioperative metrics (operative time, incision length, hospital stay), functional outcomes (Gartland-Werley score), radiographic parameters, and complication rates were compared between the groups. RESULTS: Both surgical techniques achieved successful fracture union with no significant differences in radiographic alignment or functional recovery; the majority of patients in both groups achieved "Excellent" Gartland-Werley score six months after surgery. However, the Long K-wire group demonstrated statistically significant advantages, including shorter operative times, reduced incision lengths, and decreased length of hospital stay (P < 0.05). Additionally, the Long K-wire group avoided the need for a second inpatient surgery for hardware removal, which was required for the Plate group. Complication rates, including refracture, were low and comparable between groups. CONCLUSION: Percutaneous long K-wire intramedullary fixation is an effective minimally invasive alternative in selected patients to plate fixation for treating distal radius metaphyseal-diaphyseal transition fractures. It offers minimal surgical trauma, accelerates recovery, and lowers risk of complications while ensuring comparable functional outcomes. Due to these advantages, this technique should be regarded as a clinically useful attempt for pediatric patients.