Distal Radius Fractures: A Contemporary Review of Classification, Management, and the Evidence on Anatomy Versus Function

Distal radius fractures (DRFs) are among the most common injuries in orthopedic practice and exhibit a bimodal age distribution, comprising high-energy injuries in younger patients and low-energy, osteoporosis-related fractures in older adults.Many heal well with closed reduction and cast immobilization, but a substantial proportion are unstable or displaced, prompting consideration of surgery.Over the past two decades, volar locking plate (VLP) fixation has become the dominant operative technique.However, randomized trials and recent meta-analyses consistently show that superior radiographic restoration does not reliably translate into superior patient-reported functional outcomes and that this discrepancy may become more pronounced with age.Many older adults with lower functional demands gain no clinically meaningful functional advantage from surgery, whereas younger, higher-demand patients and those with substantially displaced intra-articular fractures may benefit.Current guidelines therefore treat 65 years as a pragmatic threshold beyond which the functional benefits of surgery tend to diminish.This review summarizes the relevant anatomy, the evolution of classification systems, evaluation and imaging, comparative treatment evidence, management in older adults, complications, and rehabilitation.