Comparison of Clinical Outcomes between General Anesthesia and Local Anesthesia in Closed Reduction and K-wire Fixation of Distal Radius Fractures

Abstract

Purpose: To evaluate whether local anesthesia (LA) via a combined hematoma block with percutaneous site infiltration is non-inferior to general anesthesia (GA) for closed reduction and percutaneous Kirschner wire (K-wire) fixation of displaced distal radius fractures.

Methods: This study, conducted at a tertiary referral center in western Thailand, included 62 patients with closed, displaced distal radius fractures, allocated to either the LA (n=31) or the GA (n=31). The primary outcomes were radiological parameters (radial height, radial inclination, volar tilt, and ulnar variance) assessed immediately and at 6 weeks. Secondary outcomes included postoperative pain (visual analog scale, VAS), complication rates, and total direct medical costs (Thai Baht, THB).

Results: All four radiological parameters were comparable between the groups at both assessment points (all P≥0.05). The upper 95% CI bounds for the volar tilt difference were 3.56° (immediate) and 3.72° (6weeks), both below the predefined minimal clinically important difference of 5°. Postoperative VAS pain scores were comparable at both assessment points (P=0.513 and P=0.839, respectively). No pin-tract infections or anesthesia-related adverse events occurred in either group. The loss of reduction was 3.2% in each group (P=1.000). Total direct medical costs were significantly lower in the LA group (median 9,136 THB [IQR 8,589–13,676] vs. 12,417 THB [IQR 9,643–16,182]; median difference -3,281.75 THB; P=0.019), representing an approximately 26% cost reduction.

Conclusions: The combined LA technique achieved radiological reduction quality non-inferior to that of GA and comparable postoperative pain control to that of GA, while significantly reducing direct medical costs.