A Scoping Review of the WRIST Trial and Its Subanalyses: Implications for Care of Elderly Distal Radius Fractures

Distal radius fractures are common injuries in older adults. There is disagreement on the optimal treatment options for distal radius fractures in this patient population. The Wrist and Radius Injury Surgical Trial (WRIST) was a randomized clinical trial comparing the most common treatment options for distal radius fractures in this population (casting, closed reduction and percutaneous pinning [CRPP], external fixation [EFP], and volar locking plate systems [VLPS]). The objective of this review is to summarize the findings across all articles stemming from the data collected in the WRIST study.

This was a scoping review that involved identification of and data collection from all articles published by the WRIST group, including the initial WRIST study and all secondary analyses of the data collected.

No notable differences were found in functional outcomes between patients treated with casting vs. surgery (or between the three surgical options) at 12 months posttreatment. Patients treated with VLPS recovered faster and had improved outcomes at 6 weeks posttreatment. Complications were common and highest in the casting group, although malunion was not associated with inferior outcomes. Highly active patients recovered faster, especially when treated with VLPS. Casting was the most cost-effective option, followed by CRPP.

There is no single best option for the treatment of distal radius fractures in older adults across all domains. This allows physicians to engage in a shared decision-making conversation with each patient about their goals posttreatment in the context of their fracture pattern and overall lifestyle.