HAND/WRIST
With the pretty awful winter we just endured, injuries coming into our office were quite common. One of the most common that I saw these past few months was distal radius fractures. Distal radius fractures—commonly known as wrist fractures—are among the most frequent injuries orthopedic surgeons encounter. Deciding whether to treat these fractures surgically or non-operatively is rarely straightforward. Instead, it involves balancing objective clinical findings with patient-specific factors. At the core of this decision is fracture alignment: if the broken bone is well-aligned or can be realigned (reduced) and maintained in a cast, non-operative treatment is often appropriate. However, when fractures are significantly displaced, unstable, or involve the joint surface, surgery becomes more strongly considered to restore anatomy and function.
Stability is another critical factor. Some fractures may look acceptable on initial X-rays but are prone to shifting over time, especially in the first one to two weeks after injury. Surgeons assess patterns such as comminution (multiple fragments), dorsal angulation, or shortening of the radius, all of which increase the likelihood that a fracture will lose alignment in a cast. Advanced imaging like CT scans may also be used when joint involvement is suspected, as even small irregularities in the joint surface can lead to long-term stiffness or (post-traumatic) arthritis if left uncorrected.
Equally important are patient-specific considerations. Age, activity level, bone quality (osteoporosis), hand dominance, and occupational demands all play a role. A young, active individual or someone whose work requires fine wrist motion may benefit more from surgical fixation to optimize alignment and enable earlier movement. In contrast, an older patient with lower functional demands or significant medical comorbidities may do very well with non-operative treatment, even if the fracture heals with some degree of deformity. Patient preferences, tolerance for surgery, and ability to comply with postoperative rehabilitation are also essential parts of the conversation.
Hand surgeons will assess radiographic measurements such as volar tilt, radial height, radial inclination and ulnar variance when we assess x-rays. We use literature (peer reviewed scientific studies) and our experience to help in our choices. Patient variables are a huge part of the treatment option.
Ultimately, the decision is a shared one between surgeon and patient, guided by both science and individual goals. While surgical techniques have advanced and can offer excellent outcomes, they are not without risks such as infection, anesthesia risk, tendon irritation, or hardware complications. Non-operative care, though less invasive, requires close follow-up to ensure the fracture remains stable during healing. The best approach is tailored—aimed not just at healing the bone, but at restoring the patient’s function and quality of life.
