Effect of closed reduction with external fixation versus open reduction and locking plate internal fixation on postoperative wrist function in elderly patients with distal radius fractures

Distal radius fractures are common in elderly patients and often lead to functional impairment. This study compared closed reduction with external fixation (EF) and open reduction with locking plate fixation (LP) in elderly patients. A retrospective analysis was conducted on 80 elderly patients with unilateral distal radius fractures treated in our hospital from 2021 to 2024. Patients were divided into a closed reduction and EF group (n = 40) and an open reduction and locking plate internal fixation group (n = 40), according to the surgical procedure. General demographic and fracture-related data were collected and compared between the 2 groups. Perioperative parameters, including operation time, perioperative hemoglobin changes (ΔHb), Hb decrease (ΔHb), and postoperative hospital stay, were evaluated. Perioperative outcomes, complications, Disabilities of the Arm, Shoulder and Hand (DASH) scores, wrist range of motion (ROM), and visual analogue scale (VAS) pain scores were compared. Baseline characteristics were comparable between the 2 groups. In terms of surgical parameters, the EF group demonstrated significantly shorter operative time, shorter postoperative hospital stay, and smaller perioperative hemoglobin decrease (all P < .001). Functionally, DASH scores at 3 and 6 months postoperatively were significantly lower in the locking plate group than in the EF group, and the excellent/good functional rate at 6 months was 85.0% versus 62.5% (P < .05). Wrist ROM improved over time in both groups, but the locking plate group showed better motion in all directions at 3 and 6 months, as well as a higher excellent ROM rate at 6 months (82.5% vs 65.0%, P < .05). Regarding pain, early postoperative VAS scores were similar between groups; from 1 month onward, VAS scores remained slightly lower in the locking plate group (P < .01). EF offers advantages of shorter surgery, less perioperative trauma, and faster recovery, making it suitable for patients with limited surgical tolerance. LP provides better functional recovery, wrist mobility, and long-term pain relief, and may be preferred for elderly patients with higher functional demands. Individualized treatment should be based on patient condition and functional expectations.