- Scope: Analyzed 13,356 distal radius fractures across 36 Swedish hospitals from 2013 to 2018.
- Methodology: Used instrumental variable analysis based on hospital surgical rates to reduce treatment-selection bias.
- Primary Measure: Arm and Hand Function Index of the SMFA evaluated 1-year post-injury.
- Overall Outcome: Surgery yielded an average 6.2-point lower score (more function) than casting.
- Minimal Difference: The general 6.2-point benefit fell short of the threshold for minimal clinical importance.
- Subgroup Benefit: Severe, comminuted intra-articular fractures showed a much stronger clinical benefit with surgery.
- Conclusion: Surgery is primarily recommended for specific, complex intra-articular fracture patterns rather than all subtypes.
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