Age-Stratified Sequelae After Nonoperative Distal Radius Fractures: A Propensity-Matched Cohort Study

Distal radius fractures (DRFs) in older adults are frequently managed nonoperatively. However, treating "older adults" as a single group may obscure meaningful age-related differences in outcomes. We compared early and late sequelae after initial nonoperative management of DRFs in patients aged 50 to 69 versus 70 to 89 years.

We performed a retrospective propensity-matched cohort study using the TriNetX electronic health record network. Patients with DRFs initially treated with closed management were stratified by age (50-69 vs 70-89 years) and matched 1:1 on demographics and comorbidities. We evaluated delayed operative intervention, healing complications, and neuropathic or soft-tissue sequelae up to 10 years. A 90-day landmark analysis assessed postacute events.

We identified 65 786 patients; propensity matching yielded up to 22 585 well-balanced pairs across intervals. Patients aged 50 to 69 years had higher rates of delayed surgery at all timepoints (eg, 5.03% vs 3.51% at 1 year; HR 1.49, P < .001). Nonunion, malunion, and posttraumatic arthritis were uncommon (<1%) and did not differ. Conversely, the 50 to 69 cohort demonstrated higher hazards of corrective repair, complex regional pain syndrome, and De Quervain tenosynovitis. In landmark analysis, the younger cohort remained at increased hazard of late-onset carpal tunnel syndrome and reconstructive procedures beyond 90 days.

Despite similarly low rates of fracture healing complications across age strata, patients aged 50 to 69 years were more likely to undergo delayed operative intervention and experience neuropathic and soft-tissue sequelae than those aged 70 to 89 years. These findings support age-stratified counseling after initial nonoperative management.