***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE To compare complication rates for distal radius fractures treated  operatively versus nonsurgical  in patients older than 65 years . We hypothesized that surgical intervention would improve fracture alignment , but it would be associated with more complications and equivalent functional outcomes when compared with the nonsurgical group . METHODS Patients ( operative , n = 129 ) and controls ( nonsurgical , n = 129 ) were identified from a prospect i ve clinical and operating room data base . They were matched on fracture severity ( AO-A/B/C1 vs AO-C2/C3 ) , sex , age , and energy of injury . Data on complications were extracted from medical charts using a vali date d complications checklist , and radiologic data were collected for all patients . Functional outcomes ( Patient-Related Wrist Evaluation ) at 1 year were available in only a subset of patients . We determined differences in complication and reoperation rates using a chi-square test . RESULTS A significant number of patients experienced complications in the operative group ( operative = 37 of 129 ; nonsurgical = 22 of 129 ) . The most common complication was median neuropathy ( n = 8 operative ; n = 14 nonsurgical ) , followed by surgical site infections ( n = 16 operative ; 12 of 16 were pin site infections ) and complex regional pain syndrome ( n = 4 operative ; 3 nonsurgical ) . The complication rate in patients treated with volar plate was 22 % ( 16 of 74 ) , for dorsal plate it was 50 % ( 2 of 4 ) , for external fixation it was 42 % ( 16 of 38 ) , and for percutaneous pinning it was 23 % ( 3 of 13 ) . The number of patients requiring reoperations was similar in both groups ( 11 [ 9 % ] operative ; 7 [ 5 % ] nonsurgical ) . Our secondary radiologic and functional outcomes demonstrate that despite a higher incidence of malunion in nonsurgical patients ( nonsurgical : 69 % vs operative : 29 % ) , a subset of patients from both groups ( n = 140 ) had minimal pain and disability at 1 year ( Patient-Related Wrist Evaluation operative : 16.9 ± 23.2 ; nonsurgical : 15.7 ± 17.5 ) . CONCLUSIONS In a study matching fracture severity , sex , age , and energy of injury , we found that elderly patients with distal radius fractures who underwent surgery had higher complication rates than those treated nonsurgically . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic III We carried out a prospect i ve r and omised controlled clinical trial to compare the functional and radiological outcomes of casting with percutaneous pinning in treating extra-articular distal radial fracture in an elderly Chinese population . Sixty patients were r and omly allocated by sealed envelopes to either a ‘ Cast ’ group ( n = 30 ) or a ‘ K-wire ’ group ( n = 30 ) . All patients were available for final follow-up assessment . The radiological outcomes in terms of dorsal angulation , radial inclination and radial length were statistically significantly better in the K-wire group , whereas the Mayo wrist score and quality of life , healing rate , healing time , and complications were similar . The functional outcomes and quality of life were not affected by the treatments . Both treatments had a very low rate of complication and high healing rates PURPOSE The aim of this study was to compare the functional and radiographic outcomes of dorsally displaced distal radius fractures treated by closed reduction plaster cast fixation ( CRPCF ) and external fixation ( EF ) in patients 65 years and older . METHODS This retrospective and nonr and omized study comprised 46 consecutive patients older than 65 years who had distal radial fractures . Patients were divided into 2 groups according to treatment : a CRPCF group and an EF group . All the fractures were dorsally displaced and AO/ASIF type A or C , without articular stepoff or gap . Cases were evaluated based on the criteria of Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire score , wrist range of motion , and radiologic results . RESULTS The mean follow-up period was 25.1 months . Union was achieved in all cases . Although it was not a statistically significant difference , posttreatment complications were more common in the CRPCF group ( 10 patients ) than in the EF group ( 7 patients ) . In the CRPCF group , most complications were discomfort from the cast , whereas in the EF group , most were pin site infections . The average wrist extension and ulnar deviation ( clinical ly ) and palmar tilt and radial height ( radiologically ) were statistically better in the EF group at the final follow-up . The mean DASH scores were 20.3 in the CRPCF group and 21.9 in the EF group . There was no statistically significant difference in the DASH scores ; in wrist flexion , radial deviation , pronation , supination , grip strength , or pinch strength ( clinical ly ) ; or in ulnar variance or radial inclination ( radiologically ) . There was no correlation between the DASH scores and palmar tilt and ulnar variance . CONCLUSIONS We concluded that both CRPCF and EF are useful methods for distal radius fractures in elderly patients . The results showed significant differences in wrist extension and ulnar deviation BACKGROUND Despite the recent trend toward the internal fixation of distal radial fractures in older patients , the currently available literature lacks adequate r and omized trials examining whether open reduction and internal fixation ( ORIF ) with a volar locking plate is superior to nonoperative ( cast ) treatment . The purpose of the present r and omized clinical trial was to compare the outcomes of two methods that were used for the treatment of displaced and unstable distal radial fractures in patients sixty-five years of age or older : ( 1 ) ORIF with use of a volar locking plate and ( 2 ) closed reduction and plaster immobilization ( casting ) . METHODS A prospect i ve r and omized study was performed . Seventy-three patients with a displaced and unstable distal radial fracture were r and omized to ORIF with a volar locking plate ( n = 36 ) or closed reduction and cast immobilization ( n = 37 ) . The outcome was measured on the basis of the Patient-Rated Wrist Evaluation ( PRWE ) score ; the Disabilities of the Arm , Shoulder and H and ( DASH ) score ; the pain level ; the range of wrist motion ; the rate of complications ; and radiographic measurements including dorsal radial tilt , radial inclination , and ulnar variance . RESULTS There were no significant differences between the groups in terms of the range of motion or the level of pain during the entire follow-up period ( p > 0.05 ) . Patients in the operative treatment group had lower DASH and PRWE scores , indicating better wrist function , in the early postoperative time period ( p < 0.05 ) , but there were no significant differences between the groups at six and twelve months . Grip strength was significantly better at all times in the operative treatment group ( p < 0.05 ) . Dorsal radial tilt , radial inclination , and radial shortening were significantly better in the operative treatment group than in the nonoperative treatment group at the time of the latest follow-up ( p < 0.05 ) . The number of complications was significantly higher in the operative treatment group ( thirteen compared with five , p < 0.05 ) . CONCLUSIONS At the twelve-month follow-up examination , the range of motion , the level of pain , and the PRWE and DASH scores were not different between the operative and nonoperative treatment groups . Patients in the operative treatment group had better grip strength through the entire time period . Achieving anatomical reconstruction did not convey any improvement in terms of the range of motion or the ability to perform daily living activities in our cohorts OBJECTIVE To compare the differences of the efficacy between the conservative treatment and surgical treatment for unstable distal radius fractures with surgical indications . METHODS From March 2008 to July 2011 , the patients with unstable distal radius fractures were devided into the surgical treatment group and the conservative treatment group in a non r and omized manner . In the surgical group , there were 16 males and 32 females with an average age of 50.26 years old ranging from 22 to 76 years ; in the conservative treatment group there were 10 males and 27 females with an average age of 51.12 years old ranging from 42 to 79 years . The patients of two groups were almost all with falling damage trauma , which accounting for 92.94 % ( 79/85 ) , all the patients were closed injury , 41 cases were in the left side , and 44 cases in the right . Fracture in accordance with AO classification : C1 in 12 cases , C2 in 32 cases , C3 in 38 cases , B3 in 3 cases . Patients in the surgical treatment group were treated with volar locking compression plate ( LCP ) fixation and patients in the conservative were treated with manual reduction and plaster external fixation . The active wrist range of motion , pain assessment , subjective evaluation , Gartl and and Werley score , Batra radiology score and complications were observed in the last follow-up . RESULTS Forty-three patients in the surgical treatment group were followed up for an average time of 8.03 months ( 4 to 15 months ) ; 33 paitents in the conservative group were followed up for an average time of 6.54 months ( 2 to 9 months ) . The difference of the wrist joint active dorsiflexion and supination rotation range in the two groups were statistically significant ( t = 2.212 , P < 0.05 ; t = 2.392 , P < 0.05 ) ; the difference of the proportion of patients with ulnar wrist pain in the two groups was statistically significant ( chi2 = 5.71 , P < 0.05 ) ; the difference of patients ' subjective evaluation score of two groups was statistically significant ( Z = 2.13 , P < 0.05 ) ; the difference of Gartl and and Werley score between the two groups was statistically significant ( Z = 2.36 , P < 0.05 ) ; the difference of Batra radiology score in the two groups was statistically significant ( Z = 2.58 , P < 0.05 ) ; the differences in the X-ray measurement of the proportion of distal radial shortening > or = 5 mm , the radial height ( shortening ) was statistically significant ( for the correction chi2 = 7.57 , P < 0.05 ; t = 2.016 , P < 0.05 ) ; the differences of malunion rate , ulnar impaction syndrome , the incidence rate of ulnar styloid fracture nonunion of two groups was statistically significant ( adjusted chi2 = 10.05 , P < 0.05 ; chi2 = 8.39 , P < 0.05 ; chi2 = 5.51 , P < 0.05 ) . CONCLUSION For patients with surgical indications for unstable distal radius fractures , every indicator of the outcome after surgery in the treatment is better than that of the manipulative reduction and plaster fixation BACKGROUND From 2000 to 2012 , the annual incidence of inpatient treatment for distal radius fracture in Germany rose from 65 to 86 per 100 000 persons . It is unclear whether open reduction and volar angle-stable plate osteo synthesis ( ORIF ) , a currently advocated treatment , yields a better functional outcome or quality of life than closed reposition and casting . METHODS In the ORCHID multi-center trial , 185 patients aged 65 and older with an AO type C distal radial fracture were r and omly assigned to ORIF or closed reposition and casting . Their health-related quality of life and h and /arm function were assessed 3 and 12 months afterward with the Short Form 36 ( SF-36 ) question naire and the Disability of the Arm , Shoulder and H and ( DASH ) question naire . The radiological findings , range of movement of the wrist , and EuroQol-5D ( EQ-5D ) scores were documented as well . RESULTS Among the 149 patients in the intention-to-treat- analysis , there was no significant difference in SF-36 scores between the two treatment groups at one year ( mean difference , 3.3 points in favor of ORIF ; 95 % confidence interval , -0.2 + 6.8 points ; p = 0.058 ) . The DASH scores showed moderately strong , but clinical ly unimportant effects in favor of ORIF , and there was no difference in EQ-5D scores . ORIF led to better radiological results and wrist mobility at 3 months , with comparable results at 12 months . 37 of the patients initially allotted to nonsurgical treatment underwent secondary surgery due to significant loss of reduction . CONCLUSION The findings with respect to mobility , functionality , and quality of life at 12 months provide marginal and inconsistent evidence for the superiority of volar angle-stable plate osteo synthesis over closed reduction and casting in the treatment of intra-articular distal radius fractures . Primary nonsurgical management is also effective in suitable patients OBJECTIVE To examine the incidence and predictors of complex regional pain syndrome type I ( CRPS I ) after fracture of the distal radius . DESIGN Prospect i ve study . SETTING University hospital . PARTICIPANTS A consecutive sample of patients ( N=90 ) with fracture of the distal radius treated by closed reduction and casting .  INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Occurrence of CRPS I , occurrence of pain , wrist and h and range of motion , radiographic measures , Patient-Rated Wrist Evaluation , Hospital Anxiety and Depression Scale , and Medical Outcomes Study  
    Output:
    
The nonsurgical group had significantly greater wrist flexion , radial deviation , and ulnar variance and less radial inclination than the surgical group .
Conclusions Surgical and nonsurgical methods produce similar results in the treatment of DRFS in the elderly , and minor objective functional differences did not result an impact on subjective function outcome and quality of life