## 4 Discussion  
Distal radius fractures (DRFs) represent a common clinical challenge, particularly in elderly patients with osteoporosis. Our study provides a five-year comparative analysis of two widely used surgical techniques: percutaneous Kirschner wire fixation (PKW) and volar locking plate fixation (VLP). The results indicate that both techniques yield satisfactory long-term functional outcomes, with no statistically significant differences in DASH, PRWE, or MAYO scores. However, VLP demonstrated advantages in early functional recovery and anatomical restoration, particularly for intra-articular fractures [15]. Complications associated with VLP fixation have been widely documented in the literature. One of the major concerns is the risk of flexor tendon injuries, particularly involving the FPL, which has been linked to polar plating techniques [21, 22]. The potential wear of the FPL tendon due to implant positioning has been confirmed in cadaveric studies, highlighting the importance of screw placement and plate design in reducing these risks [22]. Another critical aspect is the stability of reduction following osteosynthesis with volar locking plates. Recent studies have demonstrated that epiphyseal screw positioning can significantly influence the risk of secondary displacement, affecting long-term outcomes [20]. While VLP offers better anatomical restoration and early functional recovery, complications such as implant-related discomfort, tendon irritation, and plate prominence have been reported [24]. These findings further support the need for individualized treatment planning, considering fracture type, bone quality, and patient activity level. Our findings align with previous randomized controlled trials (RCTs) and meta-analyses. Recent studies have emphasized the importance of treatment selection based on fracture type and patient characteristics [25]. Specifically, VLP fixation has been associated with improved early functional outcomes and greater anatomical restoration compared to PKW, particularly in osteoporoptic patients [26]. However, as demonstrated in the CROSSFIRE study, in elderly patients, closed reduction and percutaneous fixation may offer similar long-term results, minimizing surgical morbidity [27]. Furthermore, functional recovery outcomes are also influenced by fracture classification. [PERSON] et al. [28] found that volar plating provides better stabilization in complex fractures, supporting our findings of improved early rehabilitation in VLP-treated patients. [PERSON] et al. reported no significant differences in long-term functional outcomes between PKW and VLP at five years, despite initial advantages in wrist function for VLP in the early postoperative period [11]. Similarly, [PERSON] et al. found improved functional scores at six weeks postoperatively in VLP-treated patients, but this difference diminished at later follow-ups [29]. Meta-analyses by [PERSON] et al. [13], [PERSON] et al. [10], and [PERSON] et al. [30] corroborate these findings, highlighting that while VLP offers superior early recovery, long-term outcomes remain comparable. A meta-analysis by [PERSON] et al. further corroborates these findings, comparing volar locking plating and percutaneous Kirschner wires in an adult population. Their study emphasized that while VLP offers superior early functional recovery and stability, long-term outcomes remain comparable between the two techniques, reinforcing the notion that both methods are viable treatment options depending on patient-specific factors [31]. Despite these similarities, some studies suggest that VLP may provide better grip strength and radiographic alignment. [PERSON] et al. reported superior volar tilt and radial height maintenance in VLP-treated patients [32], while [PERSON] et al. observed a lower loss of reduction rate in this group [33]. Additionally, [PERSON] et al. [34] highlighted that periarticular fractures in elderly patients treated with VLP demonstrated better functional recovery and anatomical realignment.