## 1 Introduction  
Distal radius fractures (DRFs) are a common orthopedic injury in adults, characterized by a bimodal incidence: high-energy trauma in younger patients and low-energy mechanisms in elderly patients, particularly postmenopausal women with osteoporosis. Despite their rising prevalence, especially in the elderly, standardized management guidelines remain inconsistent [1, 2]. Recent systematic reviews have compared the efficacy of polar locking plates (VLPs) and percutaneous Kirschner wire fixation (PKW), highlighting the advantages and limitations of both techniques [3]. An increase in DRF incidence, particularly in suburban populations, has been reported in some epidemiological studies, with variations in fracture patterns and treatment approaches [4]. In the United States, DRFs account for over 640,000 cases annually, representing 26-46% of fractures treated in primary care settings [5, 6, 7]. Epidemiologically, these fracturescan be categorized into three age groups with different mechanisms of injury: children, young adults, and the elderly. In young adults, DRFs occur less frequently--approximately 25% of fractures--and are primarily attributed to road traffic accidents and sports injuries [5; 8]. In individuals over 50, the incidence increases significantly, particularly in women, due to osteoporoid changes [5; 8; 9]. The surgical management of DRFs primarily relies on percutaneous Kirschner wire fixation (PKW) or volar locking plate fixation (VLP), with numerous studies comparing functional and clinical outcomes between these two techniques [1; 10; 11; 12; 13; 14; 15]. The relationship between bone mineral density, patient-related outcomes, and fracture displacement has been further explored in recent studies, showing significant variations based on age and bone quality [16]. Treatment options for distal radius fractures range from conservative methods, such as bracing, to surgical techniques like external fixation, percutaneous Kirschner wire (PKW) fixation, and volar locking plate (VLP) fixation. The choice of treatment depends on the patient's age, patient activity level, fracture type, and any associated injury. The main goal is to restore anatomical alignment and allow early mobilization to achieve the best functional recovery. Each technique has advantages and limitations. PKW fixation is a minimally invasive and cost-effective technique, offering shorter operative times and less soft tissue trauma [10]. However, it carries risks, including secondary displacement, radial shortening, implant mobilization (particularly in osteoporoid bone), and infection [12]. These complications can impact functional recovery, necessitating careful surgery planning and close clinical and radiographic monitoring. Volar locking plate (VLP) fixation has become common in the last 20 years [2; 17; 18; 19]. It provides better bone alignment and more stability and allows early movement, helping patients return to daily activities faster [2; 18]. However, it may lead to complications such as loss of reduction [20] (0-9%), infection (0-6.6%), tendon issues (tenosynovitis, FPL, and EPL ruptures [21; 22]), and complex regional pain syndrome (CRPS) (0-7%). Rare issues include nonunion, implant failure, and radial artery pseudoaneurysm [23]. In the literature, both treatments have demonstrated similar long-term outcomes, especially regarding functional recovery, despite some differences in early rehabilitation and complication profiles [11]. This study compares the long-term outcomes of intra-articular and extra-articular distal radius fractures (DRFs) treated with PKW or VLP fixation. Patients were assessed after an average of five years using clinical scores (DASH, PRWE, and MAYO Wrist Score) and radiographic evaluations to determine treatment effectiveness and functional recovery. While previous studies have compared PKW and VLP fixation, they mainly focused on short- and medium-term follow-ups with heterogeneous patient populations and varying evaluation criteria.