Surgical vs. Conservative Treatment of Distal Radius Fractures in the Elderly: A Systematic Review and Meta-Analysis

Elderly patients with distal radius fractures (DRFs) pose a significant medical challenge due to their high incidence and related healthcare costs. Both surgical methods like volar plate fixation and conservative approaches such as casting are common, yet their relative effectiveness remains unclear. This review and meta-analysis compare surgical and conservative treatments, focusing on wrist functionality, upper extremity performance, grip strength, and pain after one year. A literature search was conducted in PubMed, Cochrane Library, Scopus, and Web of Science up to November 6, 2024, to find randomized controlled trials (RCTs) for DRFs in patients aged 65 and older. Thirteen RCTs with 2400 participants were included. After one year, there was no significant difference in wrist function between groups (mean difference (MD)=-1.24; 95% confidence interval (CI) -2.61 to 0.13; p=0.78; I²=78%), but upper limb function favored surgery as measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score (MD=-2.32; 95% CI -3.66 to -0.98; p=0.0007; I²=83%). Surgical treatment significantly improved grip strength (MD=3.82; 95% CI 1.55 to 6.09; p=0.001) but resulted in higher pain levels (MD=2.73; 95% CI 1.16 to 4.31; p=0.0007). Results showed substantial heterogeneity and publication bias. Surgical treatment offers slight functional advantages in grip strength and DASH scores but is associated with higher pain; conservative treatment remains viable with minimal differences in long-term wrist function. Further high-quality studies are necessary to address heterogeneity and publication bias.