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Koenig KM et al. – Internal fixation with use of a volar plate for potentially unstable distal radial fractures provided a higher probability of painless union on the basis of available data in the literature. This long–term gain in quality–adjusted life years outweighed the short–term risks of surgical complications, making early internal fixation the preferred treatment in most cases. However, the difference was quite small. Patients, especially those over sixty–four years old, who have lower disutility for the malunion and painful malunion outcome states may prefer nonoperative treatment.

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