Distal radius fractures are among the most frequent skeletal injuries encountered in orthopedic practice, accounting for nearly one-sixth of all fractures treated in emergency departments. They occur across all age groups but exhibit a bimodal distribution resulting from high-energy trauma in young adults and low-energy falls in osteoporotic elderly individuals [1,2]. The increasing incidence among older adults has been attributed to rising life expectancy and the higher prevalence of osteoporosis, particularly among postmenopausal women [3]. The distal radius is crucial for maintaining wrist mobility, stability, and load transmission; thus, anatomical restoration is vital for optimal functional recovery. Despite major advances in surgical fixation techniques, conservative management through closed reduction and immobilization remains the mainstay for stable, extra-articular, and minimally displaced fractures [4]. This approach is particularly advantageous in resource-limited settings or among patients with medical comorbidities where surgical intervention carries increased risk. Several studies have reported favorable long-term results with non-operative management when proper reduction, immobilization, and rehabilitation protocols are followed [5]. Functional recovery depends on fracture pattern, reduction quality, patient age, bone mineral density, and compliance with post-immobilization physiotherapy. Hence, the present study was undertaken to evaluate the clinical profile, radiological pattern, and functional outcome of distal radius fractures managed conservatively. The findings aim to reaffirm the role of non-operative treatment in achieving satisfactory anatomical and functional restoration while minimizing complications.

Study Design and Setting: A prospective observational study was conducted in the Department of Orthopaedics, Government General Hospital (GGH), Kumuram bheem Asifabad, from January 2025 to June 2025. The study aimed to evaluate the clinical profile and functional outcome of patients with distal radius fractures managed conservatively. Sample Size: A total of 50 patients diagnosed with distal radius fractures and treated non-operatively were included in the study. Inclusion Criteria: Patients aged above 18 years with closed distal radius fractures. Fractures managed conservatively by closed reduction and immobilization. Patients willing to give informed consent and comply with follow-up visits. Exclusion Criteria: Open fractures or associated neurovascular injuries. Pathological or recurrent fractures. Patients with ipsilateral upper limb fractures affecting functional assessment. Individuals who underwent surgical fixation or lost to follow-up. Data Collection: After obtaining informed consent, detailed clinical and radiological evaluation was performed at presentation. Baseline data included age, sex, mode of injury, side involved, dominance, and fracture type according to the AO classification. Radiographs of the wrist in anteroposterior and lateral views were taken to assess fracture alignment and reduction quality. Treatment Protocol: All patients were managed with closed reduction under local anesthesia or short general anesthesia, followed by immobilization using a below-elbow plaster of Paris (POP) cast in the functional position. Reduction was confirmed radiologically, and the cast was maintained for 4–6 weeks. Gentle range-of-motion and grip-strengthening exercises were initiated after cast removal. Follow-up and Evaluation: Patients were reviewed at 2, 6, and 12 weeks post-reduction. Clinical parameters such as pain, deformity, range of motion, and grip strength were assessed during each visit. Functional outcome was evaluated at 12 weeks using the Gartland and Werley demerit scoring system, which includes subjective, objective, and radiological criteria. Data Analysis: All collected data were compiled and analyzed using descriptive statistics. Results were expressed as mean ± standard deviation for continuous variables and as frequency and percentage for categorical variables. Tables were used to represent demographic, clinical, and outcome data for clarity. Ethical Considerations: Institutional Ethics Committee approval was obtained prior to study initiation, and written informed consent was taken from all participants before enrolment. Confidentiality and patient privacy were strictly maintained throughout the study.

A total of 50 patients with distal radius fractures managed conservatively were evaluated in this study. The demographic distribution is summarized in Table 1. The mean age of the patients was 45.2 years, with the majority belonging to the 41–50 years (28%) and >50 years (36%) age groups. Males (64%) outnumbered females (36%), reflecting the higher exposure of men to outdoor activities and occupational trauma. The right side was more frequently involved (58%), and the predominant mode of injury was a fall on an outstretched hand (68%), followed by road traffic accidents (20%). Table 1. Demographic Profile of Patients (n = 50) Variable Category n (%) Age group (years) <30 8 (16.0) 31–40 10 (20.0) 41–50 14 (28.0) >50 18 (36.0) Gender Male 32 (64.0) Female 18 (36.0) Side involved Right 29 (58.0) Left 21 (42.0) Mode of injury Fall on outstretched hand 34 (68.0) Road traffic accident 10 (20.0) Others (sports, occupational) 6 (12.0) Table 2. Clinical and Radiological Characteristics Variable Category n (%) Fracture type (AO classification) A2 16 (32.0) A3 12 (24.0) B1 8 (16.0) C1 14 (28.0) Dominant hand involved Yes 30 (60.0) Associated injuries None 42 (84.0) Ipsilateral upper limb injury 5 (10.0) Head injury 3 (6.0) Functional outcomes assessed at 12 weeks using the Gartland and Werley scoring system are shown in Table 3. An excellent outcome was achieved in 44% of patients, good in 36%, fair in 16%, and poor in 4%. The mean functional score was 6.4 ± 4.1, indicating overall satisfactory recovery following conservative management. Table 3. Functional Outcome by Gartland and Werley Score at 12 Weeks Functional Outcome Score Range n (%) Excellent 0–2 22 (44.0) Good 3–8 18 (36.0) Fair 9–20 8 (16.0) Poor >20 2 (4.0) Mean score ± SD — 6.4 ± 4.1 Complications and functional recovery in terms of range of motion are detailed in Table 4. The most frequent complication was wrist stiffness (12%), followed by residual deformity with dorsal tilt >10° (10%) and malunion (6%). Reflex sympathetic dystrophy occurred in one patient (2%). The mean wrist flexion and extension achieved at the final follow-up were 65° ± 12° and 60° ± 14°, respectively, while the mean grip strength recovered to 82% ± 10% of the contralateral side, indicating favorable functional restoration. Table 4. Complications and Range-of-Motion Recovery Parameter n (%) / Mean ± SD Complications Residual deformity (dorsal tilt > 10°) 5 (10.0) Malunion 3 (6.0) Stiffness / restricted wrist flexion 6 (12.0) Reflex sympathetic dystrophy 1 (2.0) Mean wrist flexion (°) 65 ± 12 Mean wrist extension (°) 60 ± 14 Grip strength (% of contralateral side) 82 ± 10

Distal radius fractures represent one of the most prevalent upper limb injuries, particularly in elderly individuals with osteoporosis and in younger adults following high-energy trauma. The present prospective study of 50 patients highlights the continued significance of conservative management in achieving favorable functional outcomes when appropriate case selection and meticulous follow-up are ensured. In the present study, the mean age was in the mid-forties, with the majority of patients belonging to the 41–50 years (28%) and >50 years (36%) age groups. These findings mirror those of Lucas et al. [6], who reported a higher incidence among the active and elderly population, reflecting the age-related decline in bone density and increased susceptibility to falls. A male predominance (64%) was observed, consistent with previous epidemiological data suggesting that men are more frequently involved in outdoor activities and high-risk occupations [7]. The fall on an outstretched hand (68%) was the leading cause of injury, consistent with the classical mechanism of Colles’ fracture, which remains the most common pattern in conservatively treated cases [8]. Radiologically, AO type A2 fractures (32%) were the most common pattern, denoting extra-articular and stable configurations ideal for non-operative management. Haslhofer et al. [7] demonstrated in a randomized clinical trial that conservative therapy yields comparable outcomes to surgical intervention in older patients with similar stable fracture configurations, emphasizing that operative fixation should be reserved for complex or unstable types. The predominance of right-sided involvement (58%) in this study corresponds to the dominant-hand injury pattern reported in recent European series [6]. Functional assessment at 12 weeks using the Gartland and Werley scoring system showed excellent to good results in 80% of patients, with a mean score of 6.4 ± 4.1. These outcomes are consistent with the meta-analysis by Michael et al. [8], which revealed that in elderly individuals, conservative treatment achieved comparable short-term functional recovery to volar locking plate fixation, without the risks associated with surgery. Similarly, Ranjan et al. [9] found no significant difference in functional outcomes between different conservative casting techniques, reinforcing the reliability of closed reduction and immobilization in stable fractures. Complications were minimal in the present study. Wrist stiffness (12%), residual deformity (10%), and malunion (6%) were the most frequent, which aligns with the findings of Dehghani et al. [11], who observed that such complications are generally mild and functionally tolerable in conservatively managed cases. The low incidence of reflex sympathetic dystrophy (2%) further supports the safety of non-operative management when early mobilization and physiotherapy are implemented. The mean wrist flexion (65°), extension (60°), and grip strength recovery (82%) achieved at 12 weeks in this series demonstrate substantial functional restoration. The Wrist and Radius Injury Surgical Trial (WRIST) by Chung et al. [10] corroborates that while surgical fixation may improve radiological alignment, functional recovery over time depends more on early mobilization, rehabilitation adherence, and patient-specific factors than on operative intervention itself. Furthermore, a recent meta-analysis by Raj et al. [12] comparing above-elbow and below-elbow immobilization reported no significant difference in outcomes, validating the effectiveness of simpler, less restrictive casting methods in stable distal radius fractures.

This prospective study demonstrates that conservative management of distal radius fractures remains an effective and reliable treatment option for stable and minimally displaced fractures. In this cohort of 50 patients, the majority attained excellent to good functional outcomes with few complications. Optimal results were primarily attributed to precise anatomical reduction, adequate immobilization, and early initiation of physiotherapy, all of which played crucial roles in promoting effective recovery. The majority regained satisfactory wrist motion and grip strength by 12 weeks. Although surgical fixation offers advantages in complex or unstable patterns, conservative treatment continues to provide comparable results in selected cases, emphasizing its value as a cost-effective, safe, and functionally rewarding approach.

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