{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:04:31Z","timestamp":1784001871526,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pediatric distal diametaphyseal radius fracture (DDRF) occurs in a challenging transitional zone between the metaphysis and diaphysis, presenting distinct biomechanical characteristics. This study compared outcomes of plate versus Kirschner wire (K-Wire) fixation\u2014including different configurations\u2014in a consecutive cohort of pediatric unstable DDRF. Methods: We conducted a single-center retrospective review of 63 patients (aged 6\u201315 years) treated between 2023 and 2025, divided into plate (n = 26) and K-Wire (n = 37) groups. The K-Wire cohort was subclassified as bicortical (n = 14), bicortical + intramedullary (n = 10), and intramedullary alone (n = 13). Outcomes included alignment quality, fracture healing by modified RUST (mRUST), and the Forearm Fracture Index (FFI). Multivariable regression was used to adjust for confounding. Results: Plate patients were older (11.92 \u00b1 2.87 vs. 9.32 \u00b1 2.96 years, p &lt; 0.05) and heavier (43.23 \u00b1 11.31 vs. 30.84 \u00b1 11.19 kg, p &lt; 0.001) and had higher FFI (median 1.13 vs. 1.09, p &lt; 0.05). Multivariable regression showed plate fixation was independently associated with good alignment (adjusted OR = 14.48, p = 0.018). Bicortical K-Wires yielded the highest alignment rate among percutaneous techniques (85.7%), while bicortical + IM showed poor outcomes (0% good). The unadjusted 1-month healing advantage of K-Wires (mRUST 2.53 \u00b1 0.60 vs. 2.19 \u00b1 0.47, p = 0.022) was non-significant after adjusting for body weight (p = 0.248). The complication rate was low (3.2%, 2\/63). At final follow-up (range 6\u201318 months), all patients demonstrated unrestricted wrist motion and forearm rotation, and functional outcomes were assessed clinically without validated patient-reported outcome measures. Conclusions: Plate fixation independently predicts superior alignment, whereas the K-Wire group\u2019s higher 1-month mRUST scores were attributable to their younger, lighter profile rather than the implant itself. Among K-Wire options, bicortical configuration achieves reduction quality comparable to plates, while the bicortical + IM configuration should be avoided. In this cohort, plate fixation was more common among older, heavier patients with higher FFI, whereas younger, lighter patients more often received K-Wires; both methods demonstrated low complication rates.<\/jats:p>","DOI":"10.3390\/children13070922","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:34:44Z","timestamp":1783996484000},"page":"922","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unstable Distal Diametaphyseal Radius Fracture in Children a Retrospective Comparative Study of K-Wire Versus Plate Fixation"],"prefix":"10.3390","volume":"13","author":[{"given":"Chaojin","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Orthopedic Trauma, Children\u2019s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Hangzhou 310003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Trauma, Children\u2019s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Hangzhou 310003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Trauma, Children\u2019s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Hangzhou 310003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiqiong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Trauma, Children\u2019s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Hangzhou 310003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Trauma, Children\u2019s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Hangzhou 310003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Trauma, Children\u2019s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Hangzhou 310003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","first-page":"CD012470","article-title":"Interventions for Treating Wrist Fractures in Children","volume":"2018","author":"Handoll","year":"2018","journal-title":"Cochrane Database Syst. 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