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

Bekir Karagoz; Hünkar Cagdas Bayrak; Durmus Ekin Dincer

doi:10.1111/os.70338

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (7) :1459 -1470. DOI: 10.1111/os.70338

RESEARCH ARTICLE

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

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Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords

conservative treatment / distal radius fracture / elderly patients / loss of reduction / surgical fixation / volar plate

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Bekir Karagoz, Hünkar Cagdas Bayrak, Durmus Ekin Dincer. Surgical Versus Conservative Treatment for Intra-Articular Distal Radius Fractures With Loss of Reduction in Elderly Patients. Orthopaedic Surgery, 2026, 18 (7) : 1459-1470 DOI:10.1111/os.70338

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