Treatment options for age-stratified distal radius fractures: a network meta-analysis of randomized controlled trials
Yuwan Wu, Shuguang Gao, Xinyao He, Shenghong Chen, Heng Yin, Shuhao Wang, Pan Liu, Jiahao MengBackground:
Distal radius fractures are one of the most common orthopedic injuries worldwide, with incidence varying significantly across age groups. Although multiple treatment options exist, current evidence lacks comprehensive age-stratified comparisons to guide clinical decision-making. This study aims to determine the optimal treatment strategy for distal radius fractures across different age populations using an age-stratified network meta-analysis of randomized controlled trials (RCTs).
Materials and methods:
Systematic searches were conducted in PubMed, Embase, the Cochrane Library, and Web of Science from inception to 28 September 2025. RCTs comparing two or more interventions (cast immobilization, volar locking plate fixation, K-wire fixation, external fixation, and intramedullary nailing) were included and categorized into pediatric (≤18 years), middle-aged (>18 to ≤55 years), and older adult (>55 years) subgroups. Two independent reviewers extracted data in accordance with Preferred Reported Items for Systematic Reviews and Meta-analysis guidelines. This network meta-analysis was conducted for middle-aged and older adult groups, in which multiple interventions formed a connected network. For the pediatric group with only two interventions (cast vs K-wire), a standard pairwise meta-analysis was performed. A frequentist random-effects model was applied, with treatments ranked by SUCRA probabilities. Risk of bias was assessed via the Cochrane RoB 2 tool. Primary outcomes were VAS (Visual Analog Scale) and DASH (Disabilities of the Arm, Shoulder, and Hand) scores for middle-aged and older adults, and complication and reoperation rates for pediatric patients.
Results:
Fifty-three RCTs comprising 6026 patients were analyzed. In pediatric patients, cast immobilization demonstrated significantly lower reoperation rates compared with K-wire fixation [risk ratio (RR): 0.06, 95% confidence interval (CI): 0.01–0.29). Among middle-aged adults, plate fixation achieved the highest short-term DASH score improvement (SUCRA 1.00); mid-term results favored casting (SUCRA 0.99). For pain relief, plate fixation provided superior short-term VAS reduction versus external fixation [PF vs EF: mean difference (MD): −0.70, 95% CI: −1.35 to −0.05; SUCRA, 0.93]. For older adults, intramedullary nail fixation ranked first for short- and mid-term functional recovery (SUCRA 0.99), while Kirschner wire achieved the highest ranking (SUCRA 0.88) for long-term DASH outcomes. For VAS, plate fixation provided superior short-term pain relief versus casting (PF vs PC: MD: −0.88, 95% CI: −1.65 to −0.11), and Kirschner wire ranked first for both mid-term (SUCRA 0.96) and long-term pain control.
Conclusions:
This network meta-analysis demonstrates that optimal management of distal radius fractures is fundamentally age-dependent. Cast immobilization appears sufficient for most pediatric cases, while volar locking plates should be prioritized for middle-aged adults seeking accelerated recovery. Older adults benefit from tailored approaches that consider both immediate functional needs and sustained recovery, supporting age-specific clinical guidelines and personalized treatment selection.