Distal radius fractures in older adults: revisiting nonoperative care
BMC Musculoskeletal Disorders · 19 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Distal radius fractures in older adults are among the most common fractures you will see, and whether to cast or plate them is a frequent exam and clinic question.
The evidence
This single-centre prospective cohort from India followed 88 adults aged 60 or older with extra-articular or complete articular distal radius fractures who chose either closed reduction and casting (44) or surgical fixation (44, mostly volar plating). At 12 months, DASH disability scores were slightly better with casting (mean difference -2.2 points, 95% CI -6.6 to 2.1), well inside the pre-set non-inferiority margin of 10 points, and PRWE results were similar. Complication rates were 13.6% in both groups, and hospital stay was shorter with casting (1.2 vs 2.1 days).
DASH score at 12 months: Mean difference -2.2 (95% CI -6.6 to 2.1; DASH). The interval includes no difference. This does not establish equivalence or rule out an important effect.
Why this rigour score?
Prospective cohortDesign starting point: 40
Raised the score
- Adequately powered+6
- Aligned time zero+2.5
Lowered the score
- Important imbalance remained after adjustment−5.1
- A single centre's own patients−3.4
Methods at a glance
Recorded assessment- Confounding adjustmentInverse-probability weighting / doubly robust
- Covariate balance confirmedNot met
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerMet
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 40
- Important imbalance remained after adjustment
- −5.1
- Aligned time zero
- +2.5
- Compared against an accepted alternative
- +1.7
- Adequately powered
- +6
- A single centre's own patients
- −3.4
- Consecutive enrolment
- +2.5
- Final rigour score rounded
- 44 / 100
Study design sets the starting point and a ceiling of 82. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.For a 70-year-old with a displaced intra-articular distal radius fracture, which patient factors (hand dominance, activity level, comorbidities, bone quality) would push you toward casting versus volar plating?
2.How would you counsel an older patient who accepted a borderline closed reduction about the likely function at one year and the warning signs that should prompt reconsidering surgery?
Original publication title
Conservative management is non-inferior to surgical treatment for distal radius fractures in elderly patients: a prospective non-inferiority study