Adults Closed Distal Radial Fractures: Current Concepts in Treatment Selection and Complication Prevention.

Purpose: Closed distal radial fractures (DRFs) are among the most common adult fractures with high socioeconomic impact. Clinical decision-making remains challenging, particularly in low- and middle-income countries (LMICs), because of the heterogeneous nature of evidence and resource constraints. This study aimed to develop a risk-stratified framework for treatment selection and the prevention of complications. Methods: A structured literature search was conducted in Pubmed, Scopus, and Embase databases from January 2015 to August 2025. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and guidelines addressing closed DRF management in adults. Two reviewers independently screened titles, abstracts, and full texts. Results: Fifteen studies met the inclusion criteria: three randomized controlled trials, five systematic reviews/meta-analyses, three cohort studies, two cadaveric/technical imaging studies, one guideline summary, and one narrative review. Radiographic thresholds of radial shortening >3 mm, dorsal tilt >10°, and intra-articular step-off >2 mm were supported as surgical indications in younger or high-demand adults, but not consistently in older low-demand patients. Instability predictors, such as Lafontaine criteria, were cited frequently; however, no single factor reliably predicted redisplacement. Volar locking plate (VLP) fixation yielded earlier functional recovery in unstable or high-demand patients, but long-term outcomes converged across techniques. The SAFE-VLP checklist (safe plate position, appropriate screw length, fixation stability, and early rehabilitation) emerged as a practical tool to reduce complications related to tendon, nerve, and complex regional pain. For LMICs, pragmatic pathways emphasize high-quality casting for low-demand elderly patients, percutaneous pinning as a cost effective alternative for moderate instability, and day-surgery VLP for unstable or working-age patients, supported by tele-rehabilitation strategies. Conclusions: The management of closed DRFs should integrate radiographic criteria, instability predictors, functional demand, and health care context, rather than relying solely on radiographs for decision-making. This review provides a risk-stratified algorithm, a validated safety checklist, and an LMIC-adapted pathway to optimize outcomes and reduce complications. Type of study/level of evidence: Therapeutic V.