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Comparison of outcomes between nonsurgical and surgical treatment of distal radius fracture: a systematic review update and meta-analysis

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This study was a systematic review comparing the clinical outcomes of nonsurgical and surgical management for distal radius fractures.

Materials and methods

A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane. All databases were searched from the earliest records through June 2019 using the following Boolean operators: distal radius fracture, conservative treatment, nonoperative treatment, nonsurgical treatment, surgical treatment, and operative. All prospective and retrospective controlled trials were retrieved that directly compared the functional outcomes between the nonsurgical and surgical groups.


Five prospective studies and six retrospective comparative studies were retrieved. A total of 1049 patients were included: 529 in the nonsurgical group and 520 in the surgical group. Both types of treatment led to similar results with respect to DASH and grip strength, as well as and most other functional assessments. However, there was significant difference in radial inclination, radial length, ulnar variance and range of wrist flexion.


No significant differences in most functional assessments were found when comparing surgical and nonsurgical management of distal radius fractures. Although there were significant differences in radial inclination, radial deviation, ulnar variance, and wrist flexion, they did not seem to have impacts on the quality of wrist. Nonsurgical treatment for the distal radius fractures should be considered firstly. Indications for operative fixation should be considered carefully in the treatment of DRFs.

Level of evidence

Therapeutic study (systematic review), Level III.

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  1. Shauver MJ, Yin H, Banerjee M, Chung KC (2011) Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am 36:1282–1287

    Article  Google Scholar 

  2. Synn AJ, Makhni EC, Makhni MC, Rozental TD, Day CS (2009) Distal radius fractures in older patients: is anatomic reduction necessary? Clin Orthop Relat Res 467(6):1612–1620

    Article  Google Scholar 

  3. Koenig KM, Davis GC, Grove MR, Tosteson AN, Koval KJ (2009) Distal radial fractures in the elderly-operative compared with nonoperative treatment. J Bone Jt Surg Am 91(9):2086–2093

    Article  Google Scholar 

  4. Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Jt Surg Am 93(23):2146–2153

    Article  Google Scholar 

  5. Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY (2010) Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 35(5):736–742

    Article  Google Scholar 

  6. Chan YH, Foo TL, Yeo CJ, Chew WY (2014) Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg 19(1):19–23

    Article  Google Scholar 

  7. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M (2009) A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years- nonoperative treatment versus volar locking plating. J Orthop Trauma 23(4):237–242

    Article  Google Scholar 

  8. Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH (2010) Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur 35(3):202–208

    Article  CAS  Google Scholar 

  9. Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R (2014) Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 39(7):1280–1286

    Article  Google Scholar 

  10. Sharma H, Khare GN, Singh S, Ramaswamy AG, Kumaraswamy V, Singh AK (2014) Outcomes and complications of fractures of distal radius (AO type B and C)- volar plating versus nonoperative treatment. J Orthop Sci 19(4):537–544

    Article  Google Scholar 

  11. Toon DH, Premchand RAX, Sim J, Vaikunthan R (2017) Outcomes and financial implications of intra-articular distal radius fractures—a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management. J Orthop Traumatol 18(3):229–234

    Article  Google Scholar 

  12. Bartl C, Stengel D, Bruckner T, Gebhard F, ORCHID Study Group (2014) The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int 111(46):779–787

    PubMed  PubMed Central  Google Scholar 

  13. Handoll HH, Madhok R (2003) Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 3:CD003209

    Google Scholar 

  14. Handoll HH, Madhok R (2003) Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2:CD000314

    Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  Google Scholar 

  16. Higgins JPT, Green S (2008) Cochrane handbook for systematic reviews for intervention. Version 5.0.0:180. (updated February 2008) The Cochrane Collaboration

  17. Marcheix PS, Dotzis A, Benkö PE, Siegler J, Arnaud JP, Char-issoux JL (2010) Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg Eur 35:646–651

    Article  Google Scholar 

  18. Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N (2010) Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Jt Surg (Am) 92:1851–1857

    Article  CAS  Google Scholar 

  19. Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T, Terai T (2002) Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong) 10:9–15

    Article  Google Scholar 

  20. Orbay JL, Badia A, Indriago IR, Infante A, Khouri RK, Gonzalez E, Fernandez DL (2001) The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg 5:204–211

    Article  CAS  Google Scholar 

  21. Kamano M, Koshimune M, Toyama M, Kazuki K (2005) Palmar plating system for Colles’ fractures—a preliminary report. J Hand Surg 30:750–755

    Article  Google Scholar 

  22. Rozental TD, Blazar PE (2006) Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg (Am) 31:359–365

    Article  Google Scholar 

  23. Handoll HH, Huntley JS, Madhok R (2007) External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev 3:CD006194

    Google Scholar 

  24. Cui Z, Pan J, Yu B, Zhang K, Xiong X (2011) Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis. Int Orthop 35:1333–1341

    Article  Google Scholar 

  25. Xie X, Xie X, Qin H, Shen L, Zhang C (2013) Comparison of internal and external fixation of distal radius fractures. Acta Orthop 84:286–291

    Article  Google Scholar 

  26. Peng B, Wang J, Mao F (2013) Comparison of efficacy between the surgical treatment and plaster external fixation for treatment of unstable distal radius fractures. Zhongguo Gu Shang 26:41–46

    PubMed  Google Scholar 

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Drs He, Tian, Ji, and Han have no relevant financial relationships to disclose.

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Correspondence to Achao Han.

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He, B., Tian, X., Ji, G. et al. Comparison of outcomes between nonsurgical and surgical treatment of distal radius fracture: a systematic review update and meta-analysis. Arch Orthop Trauma Surg 140, 1143–1153 (2020).

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