{
  "abstract": "Introduction Distal radius fractures (DRFs) are common injuries, especially in older adults due to age-related frailty. Most DRFs in patients aged 60 and older are treated non-operatively since surgery offers no clinically important benefits. Although anatomical alignment has traditionally been the goal of the treatment, evidence suggests that in older populations, radiographic outcomes do not reliably correlate with functional outcomes. Current evidence, including one randomised trial, shows no functional benefit of closed reduction compared with casting alone, calling into question the routine use of the procedure in older patients. The primary objective is to evaluate whether no reduction is equivalent to closed reduction in patients aged 65 years or older with a displaced DRF, based on wrist-related pain and disability measured by the Patient-Rated Wrist Evaluation (PRWE) score at 12 months.Methods and analysis This is a multi-centre, randomised controlled, equivalence trial conducted in hospitals in Finland, Denmark, Sweden and Estonia. We aim to enrol 532 patients aged ≥65 years with a displaced DRF (AO/OTA 23A/23C). Participants will be randomised (1:1) to receive either a dorsal cast without reduction (experimental intervention) or closed reduction followed by casting (control comparator). The primary endpoint is the difference between groups assessed using the PRWE outcome score at 12 months. The equivalence margin will be set at 6 PRWE points. Key secondary endpoints will include the Numeric Rating Scale for pain, patient satisfaction, quality of life (EQ-5D-5L Index) and serious adverse events at 3 months and 12 months and cosmesis at 3 months. Our main analyses will follow an intention-to-treat principle, analysed using repeated measures mixed model.Ethics and dissemination Ethical approval has been granted by the Ethics Committee of Tampere University Hospital (R25001). Results of the trial will be disseminated through peer-reviewed journals.Protocol version 6 July 2025, v1.0.Trial registration number NCT07042139.",
  "authors": [
    {
      "affiliations": [
        "Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland",
        "Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"
      ],
      "name": "Laura Kärnä"
    },
    {
      "affiliations": [
        "Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland"
      ],
      "name": "Ville Ponkilainen"
    },
    {
      "affiliations": [
        "Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland"
      ],
      "name": "Aleksi Reito"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark"
      ],
      "name": "Helle Østergaard"
    },
    {
      "affiliations": [
        "Dept. of Orthopaedic Surgery, Zealand University Hospital Koge, Koge, Denmark"
      ],
      "name": "Stig Brorson"
    },
    {
      "affiliations": [
        "Department of Traumatology and Orthopaedics, Tartu Ulikool, Tartu, Estonia"
      ],
      "name": "Kaspar Tootsi"
    },
    {
      "affiliations": [
        "Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland"
      ],
      "name": "Katriina Paasikallio"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark"
      ],
      "name": "Tina Senholt"
    },
    {
      "affiliations": [
        "Orthopedics and biotechnology, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Yan Li"
    },
    {
      "affiliations": [
        "Orthopedic and traumatology, Oulu University Hospital, Oulu, Finland"
      ],
      "name": "Juuso Heikkinen"
    },
    {
      "affiliations": [
        "Satakunta Welfare Area, Pori, Finland"
      ],
      "name": "Juha Kukkonen"
    },
    {
      "affiliations": [
        "Department of Hand Surgery, Helsinki University Hospital and University of Helsinki*, Helsinki, Uusimaa, Finland"
      ],
      "name": "Jorma Ryhänen"
    },
    {
      "affiliations": [
        "The Parker Institute: MSU, Copenhagen University Hospital, Frederiksberg, Copenhagen F, Denmark"
      ],
      "name": "Robin Christensen"
    },
    {
      "affiliations": [
        "Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland"
      ],
      "name": "Ville M Mattila"
    },
    {
      "affiliations": [
        "Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland"
      ],
      "name": "Antti P Launonen"
    }
  ],
  "title": "Effect of no reduction versus closed reduction on distal radius fractures in adults aged 65 years and older: a protocol for the DISCLOSE randomised equivalence trial",
  "uid": "7912b5d3-31f5-5f1e-9091-25a168e604f0"
}