To assess whether surgical treatment with predominantly volar locking plates has superior clinical and radiographic outcomes to conservative treatment with cast immobilization in the treatment of distal radius fractures by reviewing and investigating the literature with a high level of evidence. Thus, we systematically searched PubMed, Web of Science, and Embase databases for clinical trials comparing surgical and conservative treatments for distal radius fractures. Data extraction was performed to access parameters that included: wrist functional assessment, such as mobility and grip strength; subjective outcomes, such as DASH score, PRWE score, and quality of life score (EQ-5D); radiographic assessment (palmar inclination, ulnar variance, and articular subluxation, etc.); and complications, such as fracture nonunion, reoperation, infection, and neurologic symptoms, and then to conduct data organization and quantitative synthesis. Finally, a total of 19 clinical trials with 2729 patients were included in this report, including 1378 in the conservative treatment group and 1351 in the surgical treatment group. In terms of recovery of wrist function, wrist joints undergoing cast immobilization gained a greater range of extension (MD 1.5°, p = 0.02), whereas surgical treatment of the range of wrist rotation was significantly greater than with conservative treatment (MD 3°, p = 0.03), and wrist grip strength was significantly improved (MD 2 kg, p = 0.04). There were no significant differences between the two groups of patients in terms of wrist flexion and anterior rotation activities. In terms of patient subjective scores, patients in the plaster immobilization group showed significant improvement in PRWE scores compared with the surgical treatment group at 3 and 12 months after treatment (MD 3–7 points, p < 0.05). There was no significant difference between the two groups in terms of ulnar varus and dorsal tilt angle correction (p > 0.05). At the level of complications, the overall complication rate was significantly lower in patients who underwent surgical treatment than in the conservative treatment group (202/1046 [19.3%] vs. 361/1065 [33.9%], p = 0.001). The conclusions drawn were that when treating distal radius fractures, surgical treatment with predominantly metacarpal plate fixation achieves superior anatomical fracture repositioning and a lower complication rate compared to cast immobilization. However, no significant advantage was demonstrated in terms of recovery of wrist function and subjective patient perception. Overall, surgical treatment is an appropriate choice for patients with high motor function requirements who need to recover quickly, whereas more conservative treatments can be considered for patients with lower functional requirements.
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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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