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The rise of volar locking plates has generated a persistent question: do improved radiographs and statistically better functional scores translate into clinically important benefit for older adults? This systematic review and meta-analysis pooled randomized controlled trials comparing volar plating with nonoperative casting in patients aged 60 years or older. The analysis found statistically better scores and grip strength in some domains with plating, but several differences fell short of thresholds usually considered clinically meaningful. This distinction is important in elderly patients, where surgical risk, frailty, bone quality and patient expectations vary widely. The evidence therefore supports a more nuanced approach than simply assuming that anatomical restoration is always worth an operation. A fitter, independent, high-demand older adult may value early recovery and improved alignment differently from a frail patient with limited functional demands. The paper also reinforces the need to discuss the time horizon of benefit: short-term gains may be more pronounced than long-term differences. For HCPs, the practical message is to individualise treatment and not let radiographic perfection replace shared decision-making.
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The rise of volar locking plates has generated a persistent question: do improved radiographs and statistically better functional scores translate into clinically important benefit for older adults? This systematic review and meta-analysis pooled randomized controlled trials comparing volar plating with nonoperative casting in patients aged 60 years or older. The analysis found statistically better scores and grip strength in some domains with plating, but several differences fell short of thresholds usually considered clinically meaningful. This distinction is important in elderly patients, where surgical risk, frailty, bone quality and patient expectations vary widely. The evidence therefore supports a more nuanced approach than simply assuming that anatomical restoration is always worth an operation. A fitter, independent, high-demand older adult may value early recovery and improved alignment differently from a frail patient with limited functional demands. The paper also reinforces the need to discuss the time horizon of benefit: short-term gains may be more pronounced than long-term differences. For HCPs, the practical message is to individualise treatment and not let radiographic perfection replace shared decision-making.
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