Triage-based Protocol for Distal Radius Fracture Management: A Pragmatic Shift from Classification to Patient-centered Decision-making

Background:The management of distal radius fractures (DRFs) is complicated by numerous classification systems that demonstrate poor interobserver reliability and limited clinical utility.This inconsistency undermines the ability to standardize treatment and reliably predict outcomes.A paradigm shift is needed toward a more pragmatic and reproducible approach.Materials and methods: This article proposes a novel, triage-based clinical protocol that moves away from subjective fracture classification.The protocol is built on a two-pillar framework grounded in high-level evidence.The first pillar, the patient profile, formally assesses age and preinjury functional demand using a proposed Patient Functional Demand Scale (PFDS).The second pillar, the fracture profile, utilizes objective, quantifiable radiographic markers of instability, as defined by established clinical practice guidelines (radial shortening >3-5 mm, dorsal tilt > 10, and intra-articular step-off > 2 mm).Results: The application of the protocol is detailed through a step-by-step algorithm that guides clinicians through a series of decision gates.This process logically triages patients into nonoperative or operative treatment pathways.The protocol's utility is demonstrated through four illustrative case studies representing common clinical archetypes, showing how it aligns treatment intensity with patient-specific needs and objective fracture characteristics. Conclusion:The triage-based protocol offers a simplified, reliable, and patient-centric alternative to traditional classification-based methods.By prioritizing patient functional goals and objective evidence of instability, this framework aims to optimize functional outcomes, enhance resource allocation, and improve the consistency of care for patients with DRFs.