Distal radius fracture fixation in the elderly: does better form equal better function?

Distal radius fractures are the most common of all fractures and account for 14% of all extremity fractures (1). Good alignment can be achieved and maintained even in elderly patients with osteoporosis (2). However, it is debatable whether the pursuit of anatomical alignment is necessary, as an acceptable alignment on radiograph does not necessarily translate to a good functional outcome. This concept was proposed as early as 1814 by Abraham Colles, who noted that sufferers of his eponymous fracture were eventually able to regain full wrist functionality, despite persistent deformity (3).