Surgical Versus Conservative Treatment for Intra-Articular Distal Radius Fractures With Loss of Reduction in Elderly...

The optimal treatment strategy for intra-articular distal radius fractures with loss of reduction in elderly patients remains unclear, particularly in AO/OTA 23-C1 and C2 fracture types. This study aimed to compare the clinical and radiological outcomes of surgical versus conservative treatment in elderly patients who developed secondary displacement after initial reduction.

In this retrospective multicenter study, 127 patients aged ≥ 65 years with AO/OTA 23-C1/C2 distal radius fractures and secondary displacement during follow-up were analyzed. Patients were managed either with continued conservative treatment (n = 78) or delayed surgical intervention (n = 49). Radiological parameters (volar tilt, radial inclination, ulnar variance, and articular step-off) and functional outcomes were evaluated at 3 and 12 months using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and the Patient-Rated Wrist Evaluation (PRWE). Grip strength was assessed bilaterally at the 12-month follow-up. Independent predictors of conversion to surgical treatment were identified using multivariate logistic regression analysis.

At the 3-month follow-up, the surgical group demonstrated significantly better radiological alignment and lower QuickDASH and PRWE scores compared with the conservative group (p < 0.01). Grip strength on the injured side was similar between groups; however, relative strength loss compared with the uninjured side was significantly lower in the surgical group (p = 0.001). At 12 months, no significant differences were observed between groups in either radiological or functional outcomes. Implant-related irritation was more frequent in the surgical group (p = 0.01), whereas malunion occurred more commonly in the conservative group (p = 0.047). Independent predictors of surgical intervention included AO/OTA 23-C2 fracture type (OR: 2.677; p = 0.023) and progressive deterioration in alignment during follow-up (OR: 15.1; p = 0.001).

Surgical treatment provided superior short-term radiological and functional outcomes in elderly patients with distal radius fractures complicated by loss of reduction; however, long-term outcomes were comparable between treatment strategies. Treatment decisions should be individualized, taking into account fracture pattern, alignment stability during follow-up, and patient-specific factors.