In this study we could demonstrate, that the influence of age is critical for wrist function. In case of patients suffering from A-type fractures treated by modern surgical therapy, the influence of the severity of the injury and surgical therapy is considered minor compared to age. Hence, the important information towards the scientific society from these data is, that the incongruent study results of post-injury function after distal radius fracture might be severely influenced by study designs, which do not respect this critical influence of age. By the strong support of these data, we therefore strongly suggest that this information should be taken into consideration for future study plans [10, 11]. This might be a similar effect as compared to studies following proximal femur fractures.
We analyzed patients from our fracture register within a retrospective cohort design, since we intended to enroll as many patients as possible overseeing the longest possible observation period. This is in line with previous published studies also using retrospective designs [12, 13].
In contrast, other authors propose that prospective randomized trials provide less biased results due to elimination of confounders [14, 15]. However, in recent discussions especially about surgical therapies, it was clearly identified, that prospective studies are also affected by potential BIAS due to surgeons preferred techniques . Nobody will deny that surgeons are influenced by a certain preferred technique and it is absolutely clear that they will perform in their preferred technique better compared to another technique, they were teached just for scientific reasons. Hence, surgical studies with randomized therapeutic branches suffer from a selection BIAS of patients and surgeons. Therefore, prospective randomized trials in surgical therapy are more and more considered to not reflecting the “real” world and scientific answers of complex question might be better answered by big data analysis of big registry data. However, it is clear that this discussion is still ongoing.
There are 3 main follow-up concepts: Calling the patients at home, inviting them to the hospital to clinically survey them and PROMs (Patient Rated Outcome Measures). As the patient satisfaction is a relevant parameter of successful treatment questionnaires display this parameter in their score. They can be used to contact many patients at a time, not leading to any costs for the patients.
Although there are many PROMs like the DASH  or the PRWE  we decided to use the Munich Wrist Questionnaire by Beirer et. al , which is focussed on the wrist and includes not only objective, but also subjective parameters. In contrast to other PROMs like the DASH Score, the MWQ is not only specific for the wrist, but it provides also informations about the objective outcome like the wrist ROM, etc..
We found that age has a significant influence on wrist function in control individuals. Hence, we strongly recommend for further studies on distal radius fractures to divide patient collective at least in a group below and a group above 65 years, similar to studies on proximal femur fractures. This was supported by other authors . Quadlbauer et al. could show that patients younger than 64 years and older than 65 years had the same good outcome after volar locking plate osteosynthesis for DRF . This comes along with the studies publicated by Tulipan et al. and others who could show the elderly also had a good outcome. They stated that osteosynthesis should be offered to the elderly  .
Women, especially elderly women were significantly more often suffering from DRF type A. This comes along with findings from other publications [2, 21]. The rate of osteoporosis in this age group is high. Niempong et al. could show that 59.5% of the patients enrolled in his study aged older than fifty years with the majority being 60-69 years old were osteoporotic . When it comes to osteoporosis, surgical treatment is more complex and complication rates are higher due to the poor bone quality. Moreover, this study showed that patients suffering from A2 fractures were significantly younger than patients suffering from the more complex A3 fracture, which might be due to the poor bone quality  .
In the control group, the function was significantly decreasing with advanced aging whereas in the patient group this influence was absent. Even the patients older than 80 years had a function similar to the younger patients. This is of great interest regarding the question whether the DRF type A should be treated surgically.
As only surgically treated patients were enrolled in this study, the control group consists of healthy individuals. For analyzing the question about conservative or surgical treatment, a control group of conservatively treated individuals would be of high interest.