{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:28:13Z","timestamp":1781296093508,"version":"3.54.1"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged \u2265 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist\/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p &lt; 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs.<\/jats:p>","DOI":"10.3390\/jcm14113766","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T03:52:08Z","timestamp":1748404328000},"page":"3766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures: A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8881-1219","authenticated-orcid":false,"given":"Daniel","family":"W\u00e6ver","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Regional Hospital Randers, Skovlyvej 15, Randers N\u00d8, 8930 Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikke","family":"Thorninger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Larsen","family":"Romme","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Regional Hospital Randers, Skovlyvej 15, Randers N\u00d8, 8930 Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tj\u00f8rnild","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Regional Hospital Randers, Skovlyvej 15, Randers N\u00d8, 8930 Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7934-2983","authenticated-orcid":false,"given":"Jan Duedal","family":"R\u00f6lfing","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark"},{"name":"Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus C, 8000 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"ref_1","first-page":"255","article-title":"Population-based prospective study on the incidence of osteoporosis-associated fractures in a German population of 200 413 inhabitants","volume":"35","author":"Westphal","year":"2012","journal-title":"J. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.hcl.2012.02.001","article-title":"The epidemiology of distal radius fractures","volume":"28","author":"Nellans","year":"2012","journal-title":"Hand Clin."},{"key":"ref_4","unstructured":"Sundhedsstyrelsen (2025, January 10). National Klinisk Retningslinje for Behandling af H\u00e5ndledsn\u00e6re Brud (Distal Radiusfraktur) 2017. Available online: https:\/\/www.sst.dk\/-\/media\/Udgivelser\/2014\/NKR-H%C3%A5ndledsn%C3%A6re-underarmsbrud\/National-klinisk-retningslinie-for-behandling-af-haandledsnaere-brud.ashx?la=da&hash=7CB223E245904E51A3B96DB08180CB01A17D229A."},{"key":"ref_5","unstructured":"(AAOS) AA of, OS (2025, January 10). Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline 2020. Available online: www.aaos.org\/drfcpg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1302\/0301-620X.96B7.33149","article-title":"The operative treatment of fractures of the distal radius is increasing: Results from a nationwide Swedish study","volume":"96-b","author":"Pettersson","year":"2014","journal-title":"Bone Joint J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.2106\/JBJS.H.01297","article-title":"Trends in the United States in the treatment of distal radial fractures in the elderly","volume":"91","author":"Chung","year":"2009","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.2106\/JBJS.I.00968","article-title":"Distal radial fractures in the elderly: Operative compared with nonoperative treatment","volume":"92","author":"Egol","year":"2010","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/S0020-1383(18)30299-7","article-title":"Distal radius fractures are difficult to classify","volume":"49","author":"Madsen","year":"2018","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-0192.R2","article-title":"Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: A randomized controlled trial of displaced distal radius fractures","volume":"103-b","author":"Hassellund","year":"2021","journal-title":"Bone Joint J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1302\/2058-5241.5.190060","article-title":"Distal radius fractures in the elderly population","volume":"5","author":"Luokkala","year":"2020","journal-title":"EFORT Open Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1001\/jamasurg.2020.5672","article-title":"Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial","volume":"156","author":"Lawson","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s13018-020-01734-2","article-title":"Nonoperative treatment versus volar locking plate fixation for elderly patients with distal radial fracture: A systematic review and meta-analysis","volume":"15","author":"Li","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s10195-022-00673-4","article-title":"VOLCON: A randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years","volume":"23","author":"Thorninger","year":"2022","journal-title":"J. Orthop. Traumatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"S\u00fcdow, H., Severin, S., Wilcke, M., Saving, J., Sk\u00f6ldenberg, O., and Navarro, C.M. (2022). Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70\u2009years\u2014A three year follow-up of a randomized controlled trial. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05394-7"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1177\/1753193417727139","article-title":"Intra-articular distal radius fractures in elderly patients: A randomized prospective study of casting versus volar plating","volume":"43","year":"2018","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1001\/jamasurg.2022.0809","article-title":"Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients","volume":"157","author":"Lawson","year":"2022","journal-title":"JAMA Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Pedersen, J., Mortensen, S.O., R\u00f6lfing, J.D., and Thorninger, R. (2019). A protocol for a single-center, single-blinded randomized-controlled trial investigating volar plating versus conservative treatment of unstable distal radius fractures in patients older than 65\u2009years. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2677-y"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"647","DOI":"10.2106\/00004623-198668050-00003","article-title":"Intra-articular fractures of the distal end of the radius in young adults","volume":"68","author":"Knirk","year":"1986","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"30","DOI":"10.2519\/jospt.2014.4893","article-title":"Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH)","volume":"44","author":"Franchignoni","year":"2014","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.jse.2008.12.015","article-title":"Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain","volume":"18","author":"Mintken","year":"2009","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_22","first-page":"A5306","article-title":"Validation of the Danish version of the Quick-Disabilities of Arm, Shoulder and Hand Questionnaire","volume":"63","author":"Eggers","year":"2016","journal-title":"Dan. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1758998318807238","article-title":"Danish version of the Patient-Rated Wrist\/Hand Evaluation questionnaire: Translation, cross-cultural adaptation, test\u2013retest reliability and construct validity","volume":"24","author":"Hansen","year":"2018","journal-title":"Hand Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3235","DOI":"10.1007\/s11999-015-4376-9","article-title":"The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures","volume":"473","author":"Walenkamp","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1007\/s00590-020-02700-8","article-title":"Long-term follow-up of distal radius fractures, an evaluation of the current guideline: The relation between malunion, osteoarthritis and functional outcome","volume":"30","author":"Visser","year":"2020","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/00005131-199003000-00005","article-title":"A Prospective Randomized Trial of External Fixation and Plaster Cast Immobilization in the Treatment of Distal Radial Fractures","volume":"4","author":"Home","year":"1990","journal-title":"J. Orthop. Trauma."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00402-010-1211-3","article-title":"Arthritis predicting factors in distal intraarticular radius fractures","volume":"131","author":"Lutz","year":"2011","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"156S","DOI":"10.1177\/19476035211021909","article-title":"Cartilage Injuries and Posttraumatic Osteoarthritis in the Wrist: A Review","volume":"13","author":"Andersson","year":"2021","journal-title":"Cartilage"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1002\/acr.22359","article-title":"Association of Knee Injuries With Accelerated Knee Osteoarthritis Progression: Data From the Osteoarthritis Initiative","volume":"66","author":"Driban","year":"2014","journal-title":"Arthritis Care Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Driban, J.B., Harkey, M.S., Barbe, M.F., Ward, R.J., MacKay, J.W., Davis, J.E., Lu, B., Price, L.L., Eaton, C.B., and Lo, G.H. (2020). Risk factors and the natural history of accelerated knee osteoarthritis: A narrative review. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03367-2"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jhsa.2023.11.026","article-title":"Investigation Into the Effects of Intra-Articular Steroid on Post-Traumatic Osteoarthritis in Distal Radius Fractures: A Randomized Controlled Pilot Study","volume":"49","author":"Logli","year":"2024","journal-title":"J. Hand Surg. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1055\/s-0037-1602800","article-title":"Preexisting Carpal and Carpometacarpal Osteoarthritis Has No Impact on Function after Distal Radius Fractures","volume":"6","author":"Davies","year":"2017","journal-title":"J. Wrist Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.2106\/JBJS.J.01597","article-title":"A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older","volume":"93","author":"Arora","year":"2011","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/CORR.0000000000001524","article-title":"What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials","volume":"479","author":"Woolnough","year":"2021","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.jhsa.2015.12.008","article-title":"Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis","volume":"41","author":"Chen","year":"2016","journal-title":"J. Hand Surg. Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1302\/1358-992X.2023.15.050","article-title":"OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF DISTAL RADIUS FRACTURES IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS WITH AN ELDERLY SUBGROUP ANALYSIS","volume":"105-B","author":"Bell","year":"2023","journal-title":"Orthop. Proc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"961","DOI":"10.2106\/JBJS.18.00768","article-title":"Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial","volume":"101","author":"Saving","year":"2019","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e203497","DOI":"10.1001\/jamanetworkopen.2020.3497","article-title":"Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis","volume":"3","author":"Ochen","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.injury.2020.10.091","article-title":"Patient expectations predict outcomes following distal radius fracture: A prospective cohort study using the TEFTOM questionnaire","volume":"52","author":"Fang","year":"2021","journal-title":"Injury"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1097\/CORR.0000000000000928","article-title":"Construct Validity and Precision of Different Patient-reported Outcome Measures During Recovery After Upper Extremity Fractures","volume":"477","author":"Jayakumar","year":"2019","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/17453674.2019.1568098","article-title":"Patient-reported outcomes after a distal radius fracture in adults: A 3\u20134 years follow-up","volume":"90","author":"Huizing","year":"2019","journal-title":"Acta Orthop."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/00005131-200001000-00002","article-title":"Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: A systematic overview and meta-analysis","volume":"14","author":"Bhandari","year":"2000","journal-title":"J. Orthop. Trauma."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1302\/0301-620X.83B1.0830062","article-title":"Treatment of open fractures of the shaft of the tibia","volume":"83","author":"Bhandari","year":"2001","journal-title":"J. Bone Joint Surg. Br."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3766\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:41:50Z","timestamp":1760031710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,28]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113766"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113766","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,28]]}}}