Operative Treatment Is Associated With Better Radiographic Alignment but Similar Patient-Reported Outcomes After Low-Energy Distal Radius Fractures in Women Aged ≥65 Years.

Introduction: Distal radius fractures are common in older women, but the optimal treatment remains debated. We compared conservative treatment, volar locking plate fixation, and external fixation in women aged ≥65 years with low-energy distal radius fractures, focusing on patient-reported outcomes (PROMs) and radiographic alignment. Materials and Methods: This retrospective cohort study included consecutive women aged ≥65 years treated at a tertiary center between January 2019 and January 2024. Only low-energy mechanisms, such as falls from standing height, were included. Patients were grouped according to treatment received: conservative management (n=44), open reduction and internal fixation with a volar locking plate (ORIF; n=47), or external fixation (n=43). The primary endpoint was the PRWE total score at ≥12 months. Secondary outcomes included QuickDASH, PRWE pain and function subscores, range of motion, grip strength, and radiographic parameters. Results: A total of 134 women were analyzed. The primary outcome, PRWE total score, did not differ significantly across groups: 15.40±6.71 after conservative treatment, 14.89±5.55 after volar plating, and 17.08±7.51 after external fixation (p=0.268). QuickDASH scores were 14.35±7.21, 17.86±6.57, and 15.44±7.61, respectively (p=0.058). Grip strength as a percentage of the contralateral side was also similar (88.62±5.85%, 90.09±5.54%, and 91.02±5.54%; p=0.139). Patients selected for operative treatment had better final radiographic alignment, including volar tilt (5.80±2.79°, 7.55±1.57°, and 7.07±1.65°; p<0.001) and radial height (9.73±2.42 mm, 11.77±1.91 mm, and 12.86±1.91 mm; p<0.001). Conclusions: In women aged ≥65 years with low-energy distal radius fractures, PRWE total score did not differ significantly across treatment pathways, despite better radiographic alignment in patients selected for operative treatment. Because treatment allocation was not randomized and baseline fracture morphology differed substantially between groups, these comparisons should be interpreted as descriptive observational findings after individualized treatment selection in routine practice. The absence of statistically significant differences in PROMs should not be interpreted as evidence of treatment equivalence or as a causal treatment effect.