Operative Versus Non-Operative Management of Distal Radius Fractures in Patients Over Sixty-Five

Abstract

Background: Distal radius fractures are among the most common fragility fractures in older adults, and the choice between
surgical fixation and closed reduction with casting remains contested. Objective: To synthesise randomised evidence on operative versus non-operative management of distal radius fractures in patients over sixty-five. Methods: Narrative review of randomised trials, secondary trial analyses, systematic reviews, and economic evaluations. Findings: Trials including WRIST, Saving et al., Hassellund et al., DRIFT, and DART show surgery restores earlier grip strength and alignment, but twelve-month patient-reported wrist differences are frequently small, often below the minimal clinically important difference. Radiographic malalignment does not reliably predict poor function. Economic analyses show comparable or higher cost with surgery. Conclusions: Operative fixation benefits selected physiologically robust or high-demand patients, while casting remains a reasonable default for most patients over sixty-five.