Surgical or conservative treatment in fracture of the distal radius?

Editorial to accompany the article: „The treatment of displaced intraarticular distal radius fractures in elderly patients—a randomized multicenter study (ORCHID) of open reduction and volar locking plate fixation versus closed reduction and cast immobilization“ by Christoph Bartl, Dirk Stengel et al. in this issue of Deutsches Ärzte blatt International in stage 5 do randomized studies compare the results of the new standard to those of established proce dures. There then follows stage 6, the defense stage, in which the study results are often disputed or the study designs criticized. In the extreme case, stage 7 sees the technique demonized or condemned as completely useless (3). Will volar locking plate fixation follow this path? The first randomized trial comparing volar locking plate fixation with cast treatment showed a moderate advantage of surgical treatment only in the early phase (3 months) (4).