Functional Outcome of Conservative Vs Surgical Management of Distal Radius Fractures in Adults

Background: Distal radius fractures are a very common fracturing injury in adults, often resulting in an important functional deficit and reduced quality of life. Although non-operative and surgical treatments are frequently employed, the optimal treatment strategy for adult distal radius fractures remains controversial, particularly for fractures that are unstable. The functional outcomes of the conservative and surgical groups were assessed and compared. Main Outcome Measures: Functional outcome of the two groups (conservative and surgical) was compared. Material and Methods: A total of 100 adult patients with distal radius fracture who received care at a tertiary care teaching hospital were included in this prospective comparative observational study. Patients were divided into two groups: those were given non-operative treatment (n = 50) and those received surgical stabilization with volar locking plates (n = 50). Evaluation was performed repeatedly clinically and radiologically throughout six months' follow-up. The functional results included Disabilities of the Arm, Shoulder and Hand (DASH) ratings, Patient-Rated Wrist Evaluation (PRWE) parameters, score on the Visual Analog Scale (VAS) for pain, active wrist motion ranges, hand grip strength, overall patient satisfaction, and adverse event incidences. The analysis of the data was performed using SPSS Version 26.0, produced by IBM Corporation.Data analysis was done using the SPSS version 26.0 produced by IBM Corporation. Independent Student's t-tests and Mann–Whitney U tests were used for continuous data and categorical data, respectively. Chi-square or Fisher's exact test was used for categorical distributions. A p value of < 0.05 was considered statistically significant. Result: A total of 100 patients were included, with 50 in each treatment group. The conservative and surgical groups were comparable regarding age, sex, injury side, dominant-hand involvement, trauma mechanism, fracture pattern, and follow-up duration, with no statistically significant differences between groups (all p > 0.05). Conclusion: There were no significant differences between the groups of subjects, with respect to their baseline demographic characteristics or fracture classification. Surgical patients had significantly better DASH and PRWE scores and greater wrist flex, ext, pron, and supination at six months compared to conservative patients (all p < 0.001), and had higher grip force, along with lower VAS pain, and better overall satisfaction (all p < 0.001). Comparatively higher number of cases had high grade functional recovery in post-surgery group while fracture malunion and joint stiffness were more frequent in non-operative group. A high early functional recovery and excellent wrist movement and grip strength, compared to a manageable complication rates and reduced pain intensity, with a higher patient satisfaction are achieved with operative as opposed to non-operative treatment of adult distal radius fractures. The strategically selected candidate continues to play a major role in achieving clinical success.

Keywords: Disabilities of the Arm, Shoulder and Hand (DASH); Patient-Rated Wrist Evaluation (PRWE); Wrist biomechanics; Grip strength; Adult fractures.