Introduction and objective:
This study aims to compare operative and non-operative treatments for Distal Radius Fracture (DRF) in elderly patients, and to monitor the prevalence of Post-traumatic Arthritis (PA) over a period of 2 years. Despite numerous guidelines for the treatment of DRF, there remains a lack of consensus on the first line of treatment for elderly patients.

Material and methods:
The prospective cohort study included a 2-year follow-up of 70 patients aged 65 years or older, with low-energy distal radial fractures (DRF), managed either surgically or non-surgically. All patients were screened for the onset of post-traumatic arthritis (PA) and its risk factors were assessed using standardized scores: QuickDASH, Mayo, and PRWHE for the evaluation of functionality, pain, and other risk factors associated with PA. Logistic regression and ROC curve were employed to evaluate the significance of classifiers.

Results:
Over 24 months, no significant differences were found between operative and non-operative treatments in PA development. Pain was a significant early indicator after 6 months of DRF (p 0.05). QuickDASH, Mayo, and PRWHE scores consistently assessed outcomes (Cronbach Alpha=0.848).

Conclusions:
For senior patients, non-operative management should be the first choice for DRF. Pain, though subjectively measured, may indicate early PA development before it shows on RTG. Treatment should be individualized, based on patient needs and other health conditions.