Laura Kärnä, Toni Luokkala, Sondre Hassellund, Antti P Launonen
Current evidence supports a risk-stratified approach to immobilisation and follow-up, early mobilisation after stable fixation and the systematic incorporation of return-to-work outcomes. Many protocols still derive from tradition; high-quality trials in working-age patients are needed to address radiological thresholds, operative versus nonoperative comparisons, immobilisation duration, follow-up intensity and return-to-work determinants.
BACKGROUND: Working-age adults occupy a clinically distinct position between adolescents and the elderly, and treatment decisions in this group must balance overtreatment: unnecessary surgery, prolonged immobilisation and redundant radiographic surveillance against undertreatment leading to functional impairment. We aim to identify areas where the evidence base is shifting or remains insufficient.
METHODS: This narrative review synthesises current evidence on the working-age population with distal radius fracture, focusing on diagnostic evaluation, treatment, immobilisation and follow-up.
RESULTS: After volar locking plate fixation, early mobilisation appears safe and may improve early range of motion and grip strength without compromising alignment; routine surveillance can reasonably be reduced to clinical assessment, with imaging reserved for symptomatic patients. In nonoperative treatment, the 10- to 14-day radiograph captures most secondary displacement events, while subsequent imaging, including the traditional 5- to 6-week radiograph, adds little decision-changing value in fractures acceptable at 10 days. Counselling patients to self-refer if recovery stalls is likely more efficient than routine review of every patient.Key uncertainties remain: the optimal immobilisation duration for displaced and reduced fractures; the validation of displacement thresholds against patient-reported outcomes and predict-and-operate strategies that triage fractures for surgery on presentation radiographs, which risk expanding the surgical indication.
CONCLUSION: Current evidence supports a risk-stratified approach to immobilisation and follow-up, early mobilisation after stable fixation and the systematic incorporation of return-to-work outcomes. Many protocols still derive from tradition; high-quality trials in working-age patients are needed to address radiological thresholds, operative versus nonoperative comparisons, immobilisation duration, follow-up intensity and return-to-work determinants.