Intra-Articular Versus Extra-Articular Distal Radius Fractures: Management Strategies and Outcomes

Introduction: Distal radius fractures (DRFs) are among the most common orthopedic injuries, particularly in older adults and individuals with low bone mineral density. These fractures can be broadly categorized as intra-articular or extra-articular, with the involvement of the radiocarpal joint being a critical determinant of treatment complexity and prognosis. Intra-articular fractures are generally associated with worse functional outcomes due to articular surface disruption and higher rates of post-traumatic arthritis. This literature review aims to compare intra-articular and extra-articular distal radius fractures in terms of treatment modalities and clinical outcomes. Methods: A comprehensive search was conducted across databases including PubMed, Scopus, and Cochrane Library for studies published from 2014 to 2025. The inclusion criteria focused on randomized controlled trials, observational studies, systematic reviews, and meta-analyses that evaluated treatment modalities (operative or non-operative) and reported on at least one clinical outcome. Data on surgical versus conservative treatment, complication rates, functional recovery, and radiographic outcomes were extracted and analyzed. Results: Intra-articular DRFs are more frequently managed surgically due to the need for anatomical joint surface restoration, often utilizing volar locking plate fixation. While both fracture types can yield good outcomes with appropriate management, intra-articular fractures tend to have higher complication rates, including joint stiffness, loss of reduction, and arthritis. Extra-articular fractures, particularly stable ones, may be effectively treated conservatively with closed reduction and plaster cast immobilization. However, the treatment choice is influenced by the patient's age, activity level, and fracture stability. Operative management is indicated in significant displacement, instability, open fractures, and neurovascular deficit, preferably using volar locking plates. Discussion: Meta-analyses found no significant differences in postoperative visual analog score (VAS) or Oswestry Disability Index (ODI) between PLF and interbody fusion groups. Variations in intraoperative blood loss between interbody and lateral fusion procedures are noted, potentially impacting surgical outcomes and complication rates, including neurological deficits and infections associated with interbody fusion techniques. Conclusion: Management of distal radius fractures must be individualized based on fracture pattern, patient-specific factors, and surgeon expertise. Intra-articular fractures demand precise reduction and fixation to preserve joint congruity and function, while extra-articular fractures often allow for conservative treatment with favorable outcomes. Future research should focus on long-term functional comparisons and cost-effectiveness of surgical interventions for both fracture types. Keywords: distal radius fracture, intra-articular, extra-articular, casting, surgery.