Distal radius fractures in working-aged adults - Do we actually know what to do with them? A narrative review

Working-age adults occupy a clinically distinct position between adolescents and the elderly, and treatment decisions in this group must balance overtreatment: unnecessary surgery, prolonged immobilisation and redundant radiographic surveillance against undertreatment leading to functional impairment. We aim to identify areas where the evidence base is shifting or remains insufficient.

This narrative review synthesises current evidence on the working-age population with distal radius fracture, focusing on diagnostic evaluation, treatment, immobilisation and follow-up.

After volar locking plate fixation, early mobilisation appears safe and may improve early range of motion and grip strength without compromising alignment; routine surveillance can reasonably be reduced to clinical assessment, with imaging reserved for symptomatic patients. In nonoperative treatment, the 10- to 14-day radiograph captures most secondary displacement events, while subsequent imaging, including the traditional 5- to 6-week radiograph, adds little decision-changing value in fractures acceptable at 10 days. Counselling patients to self-refer if recovery stalls is likely more efficient than routine review of every patient.Key uncertainties remain: the optimal immobilisation duration for displaced and reduced fractures; the validation of displacement thresholds against patient-reported outcomes and predict-and-operate strategies that triage fractures for surgery on presentation radiographs, which risk expanding the surgical indication.

Current evidence supports a risk-stratified approach to immobilisation and follow-up, early mobilisation after stable fixation and the systematic incorporation of return-to-work outcomes. Many protocols still derive from tradition; high-quality trials in working-age patients are needed to address radiological thresholds, operative versus nonoperative comparisons, immobilisation duration, follow-up intensity and return-to-work determinants.