Fractures of the distal radius remain the most common fractures approximately one-sixth of all fractures treated in emergency departments. There are three main peaks of fracture distribution: the first peak is in children ages 5 to 14, these conditions in males under age 50 & the third peak is in females over the age of 40yrs. Risk factors are decreased bone mineral density, female gender, ethnicity, heredity & early menopause have all been shown to be risk factors for this injury. Majority are being treated with plaster of paris cast following closed reduction with local anesthesia. However, other distal radial fractures require surgical management & many treatment methods are available. The outcome of these fractures is not uniformly good regardless the treatment instituted. A thorough understanding of the anatomy & biomechanics of the wrist is a prerequisite when treating these lesions. There is a strict relationship between the quality of anatomical reconstruction & the long-term functional outcome. No single treatment is the solution for every type of fracture in every kind of patient. Based on the functional anatomy, we analyze the actual treatment possibilities & try to develop strategies in the choice of treatment for different fracture types in different patient groups. Treatment aims should be to reconstruct the anatomy as good as possible, to guarantee that there is no loss of reduction & to allow for a functional outcome after treatment as soon as possible. Hence this study was concluded to compare the clinical & functional outcome of fractures of distal end of radius managed with conservative & surgical management.

The present study is an analytical study of 30 Patients with distal end radius fractures. 15 were treated with conservative management, 15 with surgical management. Out of 15 cases treated surgically, 3 were managed by K-wire, 3 with External. fixator & 9 with Plating from August 2025 to September 2026 in Department of Orthopaedics, Government General Hospital ,.Government Medical College, Paderu. The study sample was 30 patients & all these patients were included with predefined inclusion & exclusion criteria in this study. The patients underwent either surgical or conservative management. Follow up was done for 6 months. Records available in the form of admission notes, operative notes, progress notes & follow up of outpatient records were analyzed. Patients not coming up for late follow up at outpatient department were interviewed on phone. We considered a fracture united if there were no pain on palpation or attempted motion, no increase in warmth at the fracture site, no discomfort on carrying weights & serial roentgenograms demonstrated bone trabeculae crossing the fracture site. The functional, radiographic & overall results were recorded according to PRWE & Demerit point system Score. Functional grading was made depending on pain, mobility & work. Radiological grading was made based on varus or valgus deformity, shortening, signs of osteoarthritis & union of fracture. The final outcome is compared with the results available from the latest literature. Some of the intra-articular Distal radius fractures are managed conservatively because the patients are not willing for surgical management of fractures. Surgical methods adopted were Pinning, Ligamentotaxis with External fixator & Plating. Method of collection of data Inclusion criteriaMales & females of age 20 to 80 yearrs. with distal end of radius fracture who have given consent for the procedure. Patients who are medically fit for any of the management procedure when required. Exclusion criteria Patients who are medically unfit for any of the management procedure Participants who have not given consent for any of the management procedure All fractures were splinted & operated at the earliest. All the necessary clinical details were recorded in proforma prepared for this study. MANAGEMENT All patients planned for conservative and surgical management were admitted & the following investigations were done preoperatively for surgical group: Blood Urine Imaging Hb% Bleeding & Clotting time Blood grouping & Cross matching FBS & PPBS Blood urea & Serum Creatinine Albumin Sugar Microscopy Wrist Joint - AP & Lat view Chest X ray PA view CT of distal Radius with wrist* *CT of distal Radius with wrist was done for cases which required better appreciation of the fracture pattern. IMPLANTS USED Pinning External Fixation Plating K-wires - Schanz pins - 2.5, 3.5mm Ellis Plate 1mm, 1.5mm & 2mm Clamps, Connecting rods Distal radial LCP T-buttress plate L-buttress plate 2.7 system plates The results were assessed at 3 months after the procedures using the demerit point system of Gartland and Werley38 based on objective and subjective criteria, residual deformity and complications. The objective evaluation is based on the following ranges of motion as being the minimum for normal function: dorsiflexion 45 degress; palmar flexion 30degress; radial deviation 15 degrees; pronation 50 degrees and supination 50 degrees. STATISTICAL ANALYSIS: Data were analyzed using statistical analysis using, Microsoft office (Word and Excel) professional 2021 software has been used to generate graphs and tables.

In our series of 30 patients (30 distal Radius fractures), Minimum age was 20 yrs., maximum 80 yrs. with mean age of 40.35 yrs. Most common age group was 41-50 years (33%) with mean age being 41.5 years in conservative group. In surgical group most common age group was 20-30 years (30%) with mean age being 40.97 years. There were 17 males (56.67%) & 13 female (43.3%). Self fall was most common mode of injury (50%). Frykman’s type III (63.33%) & AO type B1.1 (26.6%) were most common fracture pattern. Table 1: Mode of Injury Mode of injury Conservative Percentage Surgical Percentage Total Percentage No. % No. % No. % Assault 1 6.66 2 13.33 3 10 Fall from height 0 0 1 6.66 1 3.33 RTA 4 26.66 7 46.66 11 36.66 Self-fall 10 66.66 5 33.33 15 50 Total 15 100 100 100 30 100 Table 2: Distribution of Frykman Classification in two groups Frykman Type Conservative (No.) Conservative (%) Surgical (No.) Surgical (%) Total (No.) Total (%) Type I 0 0.00 0 0.00 0 0.00 Type II 0 0.00 0 0.00 0 0.00 Type III 13 86.66 6 40.00 19 63.33 Type IV 0 0.00 1 6.66 1 3.33 Type V 0 0.00 0 0.00 0 0.00 Type VI 0 0.00 0 0.00 0 0.00 Type VII 0 0.00 5 33.33 5 16.66 Type VIII 2 13.33 3 20.00 5 16.66 Total 15 100.00 15 100.00 30 100.00 Table 3: Distribution of AO Classification in two groups AO classification Conservative % Surgical % Total % B1.1 6 40 2 13.33 8 26.66 B1.2 4 26.66 0 0 4 13.33 B2.2 1 6.66 2 13.33 3 10 B3.1 0 0 1 6.66 1 3.33 B3.2 0 0 3 20 3 10 C1.2 0 0 0 0 0 0 C1.3 2 0 0 2 6.66 C2.2 1 13.33 4 26.66 5 16.66 C3.1 1 13.33 1 6.66 2 6.66 C3.2 0 0 1 6.66 1 3.33 C3.3 0 0 1 6.66 1 3.33 Left side was more common (60%). 15 patients(50%) underwent conservative treatment. 3 patients(10%) underwent surgical treatment with k wire. 3 patients(10%) underwent surgical treatment with external fixator. 9 patients(30%) underwent surgical treatment with plating. Table 4: Distribution of Management Management No % Conservative 15 50 External Fixator 3 10 K-wire 3 10 Plating 9 30 Total 30 100 Table 5: Time for union (days) S.NO Conservative Surgical 1 180 90 2 42 42 3 42 42 4 42 42 5 42 42 6 90 90 7 42 42 8 42 42 9 42 42 10 90 42 11 42 42 12 42 42 13 90 42 14 90 42 15 90 90 Mean 67.2 51.6 Standard deviation 38.7652 19.8739 In our series of 30 patients (30 distal Radius fractures):Mean time of union at 6 weeks was seen in 45% in conservative group & 76.5 % in surgical group & at 3months was seen in 50% in conservative group & 13.5% in surgical group. Mean pain score for conservative group was 19.2 and 15.53 for surgical group. Mean pain score is significantly less associated with surgical management with P= 0.039. Table 6: Comparison of pain score Pain Score Conservative Management (No.) Conservative Management (%) Surgical Management (No.) Surgical Management (%) 01–10 6 40.00 9 60.00 11–20 4 26.66 3 20.00 21–30 2 13.33 1 6.66 31–40 2 13.33 2 13.33 >40 1 6.66 0 0.00 Total 15 100.00 15 100.00 Mean ± SD --- 19.2 ± 12.61 --- 15.53 ± 10.62 Table 7: Comparison of Functional score Conservative management Percentage Surgical management Percentage Funct ional Score No. % No. % 1-10 2 13.33 2 13.33 11-20 4 26.66 8 53.32 21-30 2 13.33 3 20.00 31-40 2 13.33 0 0 >40 5 33.33 2 13.33 Total 15 100 15 100 Mean±SD 28.06±17.09 19.66±11.95 Mean functional score is significantly better associated with surgical management with P= 0.013. Mean function score for conservative group was 28.06 and 19.66 for surgical group. Mean dorsiflexion in conservative was 57 degrees and in surgical group it is 65 degrees. Table 8: Comparison of movements- Palmar flexion Palmar flexion Conservative Percentage Surgical Percentage No % No % 0-30 3 20.00 1 6.66 31-60 4 26.66 2 13.33 61-90 8 53.33 12 80.00 Total 15 100 15 100 Mean±SD 60±27.51 68 ±16.77 Mean palmar flexion is significantly better associated with surgical management with P= 0.003 Mean palmar flexion for conservative group was 60 degrees and for surgical group it is 68 degrees. Mean arc of dorso-palmar flexion for conservative group is 117 degrees and 133 degrees for surgical group. Mean radial deviation was 9 degrees in conservative and surgical group. Mean ulnar deviation for conservative group was 16 degrees and 19 degrees for surgical group. Mean arc of Radio-ulnar deviation for 24 degrees for conservative group and 26 degrees for surgical group. Table 7: Comparison of movements- pronation Pronation Conservative Percentage Surgical Percentage No % No % 0-30 2 13.33 2 13.33 31-60 2 13.33 4 26.66 61-90 11 73.33 9 60.00 Total 15 100 15 100 Mean±SD 63±27.51 73 ±28.12 Mean pronation is significantly better associated with surgical management with P= 0.037. Mean Supination for conservative group was 72 degrees and 77 degrees for surgical group. Mean arc of Pronation-supination for conservative group was 145 degrees and 140 degrees for surgical group. Excellent results were seen in 40% of cases in conservative group & 60% in surgical group. Loss of radial inclination seen in 53.33% in conservative group and 33.33% in surgical group. Loss of radial length seen in 53.33% in conservative group and 13.33% in surgical group. Intra-articular stepoff seen in 26.66% in conservative group and 6.66% in surgical group. Malunion seen in 33.33% in conservative group and 6.66% in surgical group.

We studied prospectively 30 Patients with distal end radius fracture. 15 were treated with conservative management, 15 with surgical management. Out of 15 surgical 3 were managed by K-wire, 3 by External fixator & 9 with plating. Mean age & most common age was less in surgical group. Most common age group as 41-50 years (33.0%) with mean age being 41.5 years in conservative group. Whereas in surgical group most common age group was 20-30 years (27%) with mean age being 40 years, similar to Harish Kapoor et al28 study. The best outcome or results were seen among young individuals. In our series of 30 patients, there were 17 male (56.6%) & 13 female (43.3%) similar to Harish Kapoor et al39 study. Self fall was most common mode of injury in study accounted for 50% of cases similar to study of Harish Kapoor et al39. But self-fall (65%) in conservative & RTA (65%) in surgical group was more common. Frykman’s type III was most common fracture in both the groups followed by type VIII. AO type B1.1, C2.2 & B2.2 were more common among RTA cases & among surgical group. The excellent & good outcome in conservative group was seen only in stable, minimally comminuted & minimally displaced fracture pattern. Excellent & good outcome were seen in many of such fracture pattern among surgical group. Overall Left side was more commonly injured (60%). Left side was more affected among surgical group (60%) & in conservative group (60%). Time of union is significantly less (6 weeks) associated with Surgical management (87.5%) similar to results of Toshiko Hirashima40, wherea s it was more (3 months) in conservative group (50%). 5% had union at 6 months in conservative & none in surgical. Delayed union was seen more among postmenopausal females & aged males. The percentage of loss of movement did not correlate very well with time of union. Even the patients with Time of Union of 6 weeks had greater percentage of Loss of Movements & also patients with Time of Union of 3 months had good range of movements. Similarly pain & function score at 6 months follow up did not correlate with TOU. Mean pain score was significantly less associated with surgical management with (P=0.039), values being 19.2 in conservative & 16 in surgical group. In the surgical group least being in Plating group (12) & more in K-wire group (23.1) than conservative group] similar to other studies Chin-En Chen et al41 & Carrozzella J42. Mean function score is significantly less in patients with surgical management (P= 0.013), values being 28 for conservative group & 19.6 for surgical group. In the surgical group it was least in External fixator group (8.7) & more in K-wire group (35.4). Function score was poor among the patients who delayed physiotherapy. Mean loss of movements was less in surgical group 31.6% than conservative group 34.26%. Among surgical group least was in plating (30%) & more in K- wire (35%). Mean Dorsi-flexion in conservative was 570 & in surgical group 650. Mean Palmar- flexion for conservative group was 600 & 680 for surgical group. Mean Arc of Dorso- palmar flexion for conservative group was 1170 & 1330 for surgical group. Mean Radial deviation was 90 in conservative group & surgical group. Mean Ulnar deviation for conservative group was 160 & 190 for surgical group. Mean arc of Radio-ulnar deviation for conservative group was 240 & 260 for surgical group Mean Pronation for conservative group was 630 & 730 for surgical group. Mean Supination for conservative group was 720 & 770 for surgical group. Mean arc of Pronation-supination for conservative group was 1450 & 1400 for surgical group. All movements were similar to study of Harish Kapoor et al39. In surgical group, all movements were maximum in plating group & minimum in K-wire group. Mal-union was seen in 33% cases of conservative group & 6% in surgical group. In K-wire group 30% & none in plating. Mal-union was seen in case of fractures with excess initial displacement, excess comminution treated conservative or with K-wire. Stiffness of wrist & fingers was seen in10% in both the groups. Shoulder hand syndrome was seen in 10% in conservative group & none in surgical group. Osteodystrophy was seen in 5 % in conservative group & none in surgical group. Intra-articular step was seen in 26% cases of conservative group & 6.7% in surgical group. In contrast to other studies Knirk-JL et al43, Harish Kapoor et al39, it was best corrected with plating & least with external fixator. The percentage of patients having step were 10%, 60% & 50% in plating, external fixator & K-wire groups respectively. Radial inclination was lost in 53.3% cases of conservative group & 26.7% in surgical group. Radial inclination was best restored with plating (75%) in our study & least with K-wire (30%). Radial length was lost in 53.3% cases of conservative group & 13.33% in surgical group. Radial length was best restored with plating (75%) in our study & least with K- wire (70%) in contrast to other studies Horesh et al44 & Harish Kapoor et al39 where it is best restored with external fixation. Excellent results were seen in 40% of cases in conservative group & 60% in surgical group. Excellent & good results were seen in 90% in plating & 50% in K- wire among surgical group. Results are similar to other studies Knirk J L et al40, Kapoor H et al45 & Arora J et al46

Conservative management is better in managing minimally displaced, minimally comminuted fractures. For fractures with minimal comminution, K-wires appeared to be better suited & gave better results if used with plaster. For highly comminuted fractures where no reconstruction was possible without sufficient purchase for screws, External fixator was found to be a better option. For comminuted fractures where articular reconstruction was still possible, Plating gave better results. Therefore, we cannot generalize one treatment method for all fracture patterns & treatment should be individualized to a particular fracture

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