Distal radius fractures are among the most frequently encountered skeletal injuries in orthopedic practice, accounting for nearly one-sixth of all fractures treated in emergency settings. These fractures exhibit a bimodal age distribution, occurring commonly in elderly individuals due to low-energy falls associated with osteoporosis, and in younger patients following high-energy trauma such as road traffic accidents or sports injuries (1,2).

Anatomically, the distal radius plays a crucial role in wrist biomechanics, contributing to load transmission, forearm rotation, and articulation with the carpal bones. Even minimal disruption of its alignment can significantly impair wrist function. Important radiological parameters such as radial height, radial inclination, and volar tilt are essential determinants of functional outcome, and their restoration is a key goal of treatment (3).

Historically, distal radius fractures were predominantly managed by conservative methods, especially following the description of Colles’ fracture in the early 19th century. Closed reduction and cast immobilization have remained the cornerstone of treatment for stable, extra-articular fractures. However, conservative treatment is often associated with complications such as malunion, loss of reduction, joint stiffness, and residual deformity, particularly in unstable fracture patterns (4).

With advancements in orthopedic techniques and implant design, there has been a paradigm shift toward surgical management. Techniques such as open reduction and internal fixation (ORIF) with volar locking plates, external fixation, and percutaneous pinning have gained popularity. These methods aim to achieve anatomical reduction, stable fixation, and early mobilization, thereby improving functional outcomes and reducing long-term disability (5,6).

Biomechanical studies have demonstrated that intra-articular incongruity greater than 2 mm, dorsal angulation, and radial shortening are associated with poor functional results and increased risk of post-traumatic arthritis. Consequently, surgical intervention is often recommended for displaced, comminuted, and intra-articular fractures to restore joint congruity and alignment (7).

Despite the increasing inclination toward surgical fixation, the optimal management of distal radius fractures remains controversial. Several studies have reported comparable functional outcomes between conservative and surgical approaches in selected patient populations, particularly in elderly patients with low functional demands (8). Additionally, factors such as cost, surgical risks, patient comorbidities, and resource availability play a significant role in treatment decision-making.

Functional outcome assessment has evolved with the use of validated scoring systems such as the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Gartland and Werley scoring system, which provide objective evaluation of pain, range of motion, grip strength, and overall disability (9).

Given the diversity in fracture patterns and patient characteristics, it is essential to critically evaluate the effectiveness of both conservative and surgical treatment modalities. This study aims to compare the functional outcomes of distal radius fractures managed by these two approaches and to identify factors influencing treatment success.

MATERIALS AND METHODS:

Study Design

This study was conducted as a hospital-based comparative observational study to evaluate and compare the functional outcomes of distal radius fractures managed conservatively and surgically.

Study Setting

The study was carried out in the Department of Orthopaedics at a tertiary care teaching hospital, where a large number of trauma patients are routinely managed.

Study Duration

The study was conducted over a period of one year, including patient recruitment, treatment, and follow-up.

Sample Size

A total of 60 patients diagnosed with distal radius fractures were included in the study and divided into two groups:

• Group A (Conservative group): 30 patients
• Group B (Surgical group): 30 patients

Sampling Method

Patients were selected using consecutive sampling, including all eligible patients presenting during the study period who met the inclusion criteria.

Inclusion Criteria

• Patients aged ≥18 years
• Closed distal radius fractures
• Both extra-articular and intra-articular fractures
• Patients willing to participate and provide informed consent
• Patients available for follow-up

Exclusion Criteria

• Open fractures
• Associated neurovascular injury
• Pathological fractures
• Previous fracture or deformity of the same wrist
• Polytrauma patients unable to comply with rehabilitation
• Patients lost to follow-up

Pre-treatment Evaluation

All patients underwent:

• Detailed history taking (mode of injury, hand dominance, comorbidities)
• Thorough clinical examination (swelling, deformity, neurovascular status)
• Standard radiological assessment:
• X-ray wrist (AP and lateral views)
• Evaluation of:
• Radial height
• Radial inclination
• Volar tilt
• Articular involvement

Fractures were classified using Frykman / AO classification system.

Treatment Protocol

Group A: Conservative Management

• Closed reduction performed under hematoma block or sedation
• Immobilization using below-elbow plaster cast
• Reduction confirmed radiologically
• Cast maintained for 4–6 weeks
• Periodic X-rays taken to assess maintenance of reduction
• After cast removal:
• Wrist mobilization exercises initiated
• Physiotherapy advised

Group B: Surgical Management

The choice of surgical procedure depended on fracture type and surgeon preference:

Common techniques used:

• Open Reduction and Internal Fixation (ORIF) with volar locking plate
• Percutaneous K-wire fixation
• External fixation (in comminuted fractures)

Surgical steps (for ORIF):

• Volar approach (Henry approach)
• Fracture reduction under direct visualization
• Fixation with locking plate
• Wound closure and sterile dressing

Postoperative care:

• Limb elevation
• Early finger mobilization
• Sutures removed on 10–14 days
• Wrist mobilization started early (2–3 weeks depending on stability)

Follow-Up Protocol

Patients were followed up at:

• 2 weeks
• 6 weeks
• 3 months
• 6 months

At each visit:

• Clinical examination
• Radiological assessment
• Functional evaluation

Outcome Measures

Primary Outcome

• DASH (Disabilities of Arm, Shoulder and Hand) Score

Secondary Outcomes

• Gartland and Werley Score
• Range of motion:
• Palmar flexion
• Dorsiflexion
• Supination and pronation
• Grip strength (if available)
• Radiological parameters:
• Radial height
• Radial inclination
• Volar tilt

Assessment Criteria

Functional Outcome Grading

Based on scoring systems:

DASH Score Interpretation:

• 0–25 → Excellent
• 26–50 → Good
• 51–75 → Fair
• 75 → Poor

Complications Assessed

• Malunion
• Wrist stiffness
• Complex regional pain syndrome (CRPS)
• Infection (surgical group)
• Tendon irritation or rupture
• Implant-related complications

Statistical Analysis

All collected data were entered into Microsoft Excel and analyzed using SPSS 19.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The comparison between the conservative and surgical groups was performed using the independent sample t-test for continuous variables and the Chi-square test for categorical variables.. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

The study was conducted after obtaining approval from the Institutional Ethics Committee. Written informed consent was obtained from all participants prior to their inclusion in the study.

RESULTS:

The age distribution between the conservative and surgical groups was comparable, indicating no significant difference between the two groups as shown in table 1.

Table 1. Age distribution

There was no statistically significant difference in gender distribution between the two groups as shown in table 2.

Table 2. Gender distribution

A statistically significant difference was observed in the mode of injury, with road traffic accidents being more frequent in the surgical group as shown in table 3.

Table 3. Mode of injury

* Significant

There was a statistically significant difference in fracture type distribution, with intra-articular fractures being more common in the surgical group as shown in table 4.

Table 4. Fracture type

* Significant

The surgical group showed significantly better functional outcomes compared to the conservative group as shown in table 5.

Table 5. Functional outcome (DASH score after 6 month follow-up)

* Significant

Range of motion was significantly better in the surgical group across all movements as shown in table 6.

Table 6. Range of motion

* Significant

Radiological parameters were significantly better restored in the surgical group as shown in table 7

Table 7. Radiological parameters

 * Significant

Complications, particularly malunion, were more frequent in the conservative group, and this difference was statistically significant as shown in Table 8.

Table 8. Complications

* Significant

DISCUSSION:

Distal radius fractures are among the most frequently encountered orthopedic injuries, and their management continues to evolve with advancements in surgical techniques. The present study compared the functional and radiological outcomes of distal radius fractures managed conservatively and surgically, highlighting important differences between the two approaches.

In the present study, the majority of patients belonged to the middle-aged and elderly population, with a higher proportion of females in the conservative group. This observation is consistent with the known epidemiology of distal radius fractures, where osteoporotic changes predispose elderly females to low-energy fractures (10,11).

The mode of injury differed significantly between the two groups, with low-energy falls being the most common cause in the conservative group, whereas high-energy trauma such as road traffic accidents predominated in the surgical group. This reflects the fact that unstable fractures resulting from high-energy mechanisms are more likely to require operative intervention (12).

Fracture pattern analysis revealed that extra-articular fractures were more commonly managed conservatively, while intra-articular fractures were predominantly treated surgically. This is in accordance with standard orthopedic principles, which emphasize the importance of anatomical reduction in intra-articular fractures to prevent long-term complications such as post-traumatic arthritis (13).

Functional outcomes assessed using the DASH score were significantly better in the surgical group compared to the conservative group. A greater proportion of patients in the surgical group achieved excellent and good outcomes. Similar findings have been reported in previous studies, where surgical fixation, particularly with volar locking plates, resulted in improved functional recovery (14,15).

Range of motion was also significantly better in the surgical group across all parameters. This can be attributed to stable fixation allowing early mobilization, thereby reducing stiffness and improving joint function. Comparable results have been documented in earlier studies (16).

Radiological outcomes in the present study demonstrated better restoration of radial height, volar tilt, and radial inclination in the surgical group. Maintenance of these parameters is critical for normal wrist biomechanics, and their disruption has been associated with poor functional outcomes. Previous studies have similarly emphasized the importance of anatomical alignment in achieving favorable results (17).

The complication profile varied between the two groups. The conservative group showed a higher incidence of malunion and stiffness, whereas the surgical group had complications such as superficial infection and implant-related issues. However, these complications were generally manageable and did not significantly affect overall outcomes. Similar observations have been reported in the literature (18).

Despite the advantages of surgical management, conservative treatment remains an effective option in selected cases, particularly in stable fractures and elderly patients with low functional demands. Some studies have reported comparable long-term outcomes between conservative and surgical treatment in such populations (19).

CONCLUSION:

Surgical management of distal radius fractures results in better functional recovery, improved range of motion, and superior radiological alignment, particularly in displaced and intra-articular fractures. Conservative treatment, however, remains an effective option for stable, non-displaced fractures and elderly patients with low functional demands, providing satisfactory outcomes without surgical risks. Therefore, the choice of treatment should be individualized, considering fracture pattern, patient age, bone quality, and functional requirements to achieve optimal outcomes.

REFERENCES:

1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–7.
2. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908–15.
3. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279–88.
4. Cooney WP. Fractures of the distal radius: a modern treatment-based classification. J Hand Surg Am. 1993;18(1):1–11.
5. Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002;27(2):205–15.
6. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am. 1991;73(3):461–9.
7. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647–59.
8. Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation in elderly patients. J Bone Joint Surg Am. 2011;93(23):2146–53.
9. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH. Am J Ind Med. 1996;29(6):602–8.
10. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–25.
11. MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136–45.
12. Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014;3(4):325–32.
13. Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010;18(3):180–9.
14. Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg. 2000;5(2):103–12.
15. Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radius fractures treated with external fixation, a radial column plate, or a volar plate. J Bone Joint Surg Am. 2009;91(7):1568–77.
16. Grewal R, MacDermid JC. The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment. J Hand Surg Am. 2007;32(7):962–70.
17. Forward DP, Davis TR, Sithole JS. Do intra-articular distal radius fractures result in radiocarpal arthritis? J Hand Surg Eur Vol. 2008;33(6):840–5.
18. Bentohami A, de Burlet K, de Korte N, van den Bekerom MP, Goslings JC, Schep NW. Complications following volar locking plate fixation. J Hand Surg Eur Vol. 2014;39(7):745–54.
19. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable distal radius fractures in patients older than 70 years. J Orthop Trauma. 2009;23(4):237–42.