The Effectiveness of Operative Fixation for Comminuted Distal Radial Fractures in the Hyper-aged Patients Over 75 Years Old in South Korea

<b>Background:</b> In 2025, South Korea's society is facing the transition into a hyper-ageing society. The effectiveness and functional outcome between surgical operation and conservative treatment of distal radial fractures in the elderly have been consistently debated. The aim of this study is to present the outcomes of surgical fixation for comminuted distal radial fractures in hyper-aged patients aged 75 years or older. <b>Methods:</b> This is a retrospective study of all patients aged 75 years or older who underwent surgical fixation of distal radial fractures in the period from January 2011 to December 2021 with a minimum follow-up of at least 3 months. Data collected included sex, age, residence status, economically active population, osteoporosis, AO/OTA fracture classification and use of bone graft. Functional outcomes were evaluated with Mayo wrist score system (MWSS) and radiologic outcomes between preoperative, postoperative and unaffected sides of each patient was measured. <b>Results:</b> The study included 38 patients (35 females) with a median age of 79.7 years (range: 75-92). MWSS at postoperative 6 months showed that 30 patients (78.9%) expressed excellent or good outcomes. Postoperative parameters indicated radial height 6.90 mm (4.82-9.08), radial inclination 15.5° (13.0°-19.9°) and volar tilt 10.8° (7.2°-14.5°). These values were significantly different compared with preoperative values. We identified with McNemar's test that in all time periods (2 weeks, 1 month and 3 months), there were no significant difference in the proportion of acceptable reduction in all parameters. <b>Conclusions:</b> Although treatment of distal radial fractures in the elderly is still controversial, operative treatment showed significantly improved functional and radiological outcomes and showed possibilities to reduce socioeconomic burden and to aid in early functional restoration and aesthetic deformity correction. <b>Level of Evidence:</b> Level IV (Therapeutic).