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 [1]. They occur across all age groups but exhibit a distinct bimodal distribution resulting from high-energy trauma in young adults and low-energy osteoporotic falls in the elderly [2]. Given the intricate anatomy of the wrist and its vital role in hand function, precise restoration of distal radius alignment is crucial to re-establish normal biomechanics and prevent long-term disability [3]. Over the past few decades, the management of distal radius fractures has evolved significantly, with treatment strategies determined by patient age, bone quality, fracture morphology, and functional requirements. Although surgical interventions such as volar plating, percutaneous pinning, and external fixation have gained widespread acceptance, conservative management continues to remain the mainstay for stable, minimally displaced, or extra-articular fractures [4,5]. Closed reduction followed by immobilization in a below-elbow cast remains a simple, cost-effective, and widely practiced approach, particularly in resource-limited healthcare settings. Nevertheless, despite achieving radiological union, functional outcomes following conservative treatment may vary due to residual malalignment, joint stiffness, or delayed mobilization [4]. This variation underscores the importance of periodic assessment of both clinical and radiological parameters to validate the efficacy of non-operative management and ensure optimal recovery of wrist function. The present observational study was undertaken to assess the functional outcome and complications of distal radius fractures managed conservatively, emphasizing the correlation between fracture pattern, radiological union, and overall recovery of wrist function.

This prospective observational study was conducted in the Department of Orthopaedics, Sri Lakshmi Narayana Institute of Medical Sciences, Koodapakkam, Puducherry, over a period of ten months, from May 2019 to April 2020. A total of 50 patients presenting with distal radius fractures were enrolled after obtaining institutional ethics committee approval and written informed consent. Inclusion Criteria Patients aged 20 years and above with closed distal radius fractures. Fractures that were minimally displaced or extra-articular and suitable for conservative management. Patients willing to comply with follow-up assessments. Exclusion Criteria Open or pathological fractures. Associated ipsilateral upper limb fractures or neurovascular injuries. Patients lost to follow-up or with previous wrist deformities. Procedure All patients underwent closed reduction under appropriate anesthesia, followed by immobilization with a below-elbow plaster cast in the functional position. Post-reduction radiographs were obtained in anteroposterior and lateral views to assess alignment. Reduction was considered acceptable when radial height, inclination, and volar tilt were within standard limits. Patients were reviewed at 2, 6, and 12 weeks for clinical and radiological evaluation. Assessment Parameters Radiological union was defined by cortical continuity and trabecular bridging across the fracture site in at least three cortices. Functional outcomes were assessed at 12 weeks using the Modified Gartland and Werley scoring system, which evaluated pain, deformity, range of motion, and grip strength. Any complications such as malunion, stiffness, or neurovascular symptoms were documented. Statistical Analysis Data were compiled and analyzed using descriptive statistics. Quantitative variables were expressed as mean ± standard deviation, and categorical data as frequencies and percentages. Associations between radiological and functional outcomes were evaluated using the Chi-square test, with p < 0.05 considered statistically significant.

A total of 50 patients with distal radius fractures treated conservatively were evaluated for demographic characteristics, fracture distribution, radiological healing, functional outcome, and post-treatment complications. Demographic and Clinical Profile The age of participants ranged from 21 to 72 years, with a mean age of 46.8 ± 12.4 years. The majority belonged to the 51–60-year age group (32%), followed by the 41–50-year group (28%). Males constituted 64%, indicating a higher exposure to outdoor activity-related trauma. The right side was involved in 58% of cases. The most common mechanism of injury was a fall on the outstretched hand (68%), followed by road traffic accidents (20%) and occupational or sports-related injuries (12%) (Table 1). Table 1. Demographic and Clinical Profile of Patients (n = 50) Variable Category n % Age group (years) 21–30 6 12.0 31–40 8 16.0 41–50 14 28.0 51–60 16 32.0 >60 6 12.0 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 Fracture Patterns and Radiological Findings Based on the AO classification, A2 (32%) and C1 (28%) types were the predominant patterns observed, followed by A3 (24%) and B1 (16%) fractures. Post-reduction radiographs showed acceptable alignment in 44 (88%) patients, while 6 (12%) exhibited partial loss of reduction during follow-up. Radiological union was achieved in 47 (94%) patients, with an average healing time of 9.3 ± 1.8 weeks (Table 2). Table 2. Distribution of Fracture Patterns and Radiological Findings Parameter Category n % AO Fracture type A2 16 32.0 A3 12 24.0 B1 8 16.0 C1 14 28.0 Post-reduction alignment Acceptable 44 88.0 Loss of reduction 6 12.0 Radiological union Achieved 47 94.0 Delayed (>12 weeks) 3 6.0 Mean time to union (weeks) 9.3 ± 1.8 Functional Outcomes Functional recovery was assessed at 12 weeks using the Modified Gartland and Werley scoring system. An excellent outcome was achieved in 42% and a good outcome in 30% of cases, while 18% showed fair and 10% poor recovery. The mean overall score was 4.6 ± 2.1, and a combined 72% of patients demonstrated good-to-excellent outcomes (Table 3). Functional improvement was significantly associated with optimal reduction and early mobilization. Table 3. Functional Outcome Based on Modified Gartland and Werley Score Functional Grade Score Range n % Excellent 0–2 21 42.0 Good 3–8 15 30.0 Fair 9–20 9 18.0 Poor >20 5 10.0 Mean score 4.6 ± 2.1 Overall good to excellent outcomes 36 72.0% Post-Treatment Complications Complications were noted in 11 (22%) patients. Residual wrist stiffness (10%) was the most frequent issue, followed by malunion with dorsal tilt >10° (6%), transient median nerve paresthesia (4%), and complex regional pain syndrome (2%). All complications were managed conservatively, and no cases of infection or non-union were reported (Table 4). Table 4. Post-Treatment Complications Complication n % Remarks Residual stiffness 5 10.0 Mild limitation of wrist flexion/extension Malunion (dorsal tilt >10°) 3 6.0 No significant functional deficit Transient median nerve paresthesia 2 4.0 Resolved with conservative therapy Complex regional pain syndrome 1 2.0 Managed symptomatically Total with complications 11 22.0

Distal radius fractures remain among the most frequently encountered injuries in orthopedic practice, with an increasing incidence in both elderly individuals and active adults [6]. Although surgical fixation methods such as volar plating and external fixation have gained wide popularity, conservative management continues to play a pivotal role in the treatment of stable and minimally displaced fractures, especially in resource-limited environments [7,8]. The present study analyzed the clinical and radiological outcomes of 50 patients managed non-operatively, emphasizing the effectiveness of cast immobilization in selected cases. In this series, the mean age was 46.8 years, with a male predominance (64%), which reflects the demographic pattern observed in earlier studies by Walenkamp et al. [8] and Ochen et al. [9]. These studies reported that middle-aged men are more frequently affected by high-energy trauma, while elderly women are predisposed to low-energy osteoporotic fractures. The most common mechanism of injury in the current study was a fall on the outstretched hand (68%), consistent with the classical Colles’ fracture mechanism described in the Cochrane review by Handoll and Madhok [6]. Radiological union was achieved in 94% of patients at a mean duration of 9.3 ± 1.8 weeks, comparable to the findings of Arora et al. [7], who reported union within 8–10 weeks among patients treated conservatively. The minor rate of loss of reduction (12%) in our cohort also aligns with their observations, underscoring the necessity of proper cast application and regular radiographic monitoring to prevent displacement during healing. Functional outcomes assessed using the Modified Gartland and Werley scoring system showed good to excellent results in 72% of patients. Similar satisfactory outcomes were reported in large-scale meta-analyses and randomized controlled trials comparing conservative and operative management, where non-operative treatment yielded 70–80% functional success when reduction was maintained [9,11]. These results reinforce that effective immobilization and early rehabilitation are critical determinants of recovery, particularly in fractures with preserved anatomical alignment. The overall complication rate (22%) in the present study predominantly stiffness (10%) and malunion (6%) is consistent with the findings of Mellstrand-Navarro et al. [10], who identified residual stiffness and malunion as the leading sequelae of non-operative treatment. Notably, there were no cases of non-union or infection, reaffirming the biological potential of distal radius fractures to heal favorably with conservative care. Our observations resonate with recent literature emphasizing that non-operative management remains a valid and cost-effective option for appropriately selected fractures [11,12]. The success of conservative treatment depends on the accuracy of reduction, vigilant follow-up, and timely initiation of physiotherapy. In elderly or low-demand patients, this approach achieves functional outcomes comparable to surgical fixation while minimizing procedure-related complications and healthcare costs.

Conservative management of distal radius fractures continues to be an effective and reliable treatment modality for stable and minimally displaced fractures. In this study, a high rate of radiological union (94%) and satisfactory functional outcomes (72% good to excellent) were achieved with simple closed reduction and cast immobilization. Complications were minimal and primarily related to stiffness or minor malalignment. These findings reaffirm that optimal reduction, appropriate immobilization, regular monitoring, and early physiotherapy are crucial for favorable recovery. Thus, non-operative management remains a safe, cost-effective option, particularly in settings where surgical intervention is not indicated or resources are limited.

1. Song J, Yu AX, Li ZH. Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2015 Oct 15;8(10):17023-35. PMID: 26770293; PMCID: PMC4694193. 2. Aparicio P, Izquierdo Ó, Castellanos J. Conservative Treatment of Distal Radius Fractures: A Prospective Descriptive Study. Hand (N Y). 2018 Jul;13(4):448-454. doi: 10.1177/1558944717708025. Epub 2017 Jun 5. PMID: 28581340; PMCID: PMC6081788. 3. Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018 Apr;49(2):211-222. doi: 10.1016/j.ocl.2017.12.001. PMID: 29499822. 4. Ikpeze TC, Smith HC, Lee DJ, Elfar JC. Distal Radius Fracture Outcomes and Rehabilitation. Geriatr Orthop Surg Rehabil. 2016 Dec;7(4):202-205. doi: 10.1177/2151458516669202. Epub 2016 Sep 22. PMID: 27847680; PMCID: PMC5098688. 5. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986 May;(206):202-10. PMID: 3708976. 6. Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;(2):CD000314. doi: 10.1002/14651858.CD000314. PMID: 12804395. 7. Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. 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 Joint Surg Am. 2011 Dec 7;93(23):2146-53. doi: 10.2106/JBJS.J.01597. PMID: 22159849. 8. Walenkamp MMJ, Mulders MAM, Goslings JC, Westert GP, Schep NWL. Analysis of variation in the surgical treatment of patients with distal radial fractures in the Netherlands. J Hand Surg Eur Vol. 2017 Jan;42(1):39-44. doi: 10.1177/1753193416651577. Epub 2016 Sep 28. PMID: 27289051. 9. Ochen Y, Peek J, van der Velde D, Beeres FJP, van Heijl M, Groenwold RHH, Houwert RM, Heng M. Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Apr 1;3(4):e203497. doi: 10.1001/jamanetworkopen.2020.3497. PMID: 32324239; PMCID: PMC7180423. 10. Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J. 2014 Jul;96-B(7):963-9. doi: 10.1302/0301-620X.96B7.33149. PMID: 24986952. 11. Testa G, Vescio A, Di Masi P, Bruno G, Sessa G, Pavone V. Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years. J Funct Morphol Kinesiol. 2019 May 17;4(2):26. doi: 10.3390/jfmk4020026. PMID: 33467341; PMCID: PMC7739362. 12. Walenkamp MM, Goslings JC, Beumer A, Haverlag R, Leenhouts PA, Verleisdonk EJ, Liem RS, Sintenie JB, Bronkhorst MW, Winkelhagen J, Schep NW. Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial. BMC Musculoskelet Disord. 2014 Mar 19;15:90. doi: 10.1186/1471-2474-15-90. PMID: 24642190; PMCID: PMC4234244.