## 4 Discussion
However, these advantages did not consistently translate intosuperior long-term functional outcomes, reinforcing our findings that both techniques are viable options depending on patient-specific factors. The comparable long-term results suggest that treatment choice should be individualized. VLP appears preferable for complex intra-articular fractures requiring stable fixation and early mobilization, while PKW remains a viable option for extra-articular fractures, particularly in osteoporotic patients or those with higher surgical risk. Additionally, PKW offers advantages such as reduced cost, shorter surgical time, and less soft tissue disruption, albeit at the expense of potential secondary displacement [10; 23; 24]. Despite the relatively small sample size (n = 42), this study provides valuable insight due to several strengths. The five-year follow-up is among the longest reported in similar comparative studies, and the absence of patient loss ensures data completeness and reliability. Additionally, the stratification of patients based on fracture type and treatment modality allows for a more detailed assessment of outcomes. While the retrospective nature of this study introduces potential selection bias and limits the control of confounding variables, the findings align with the existing literature, reinforcing the notion that treatment decisions should be tailored to individual patient characteristics rather than assuming the superiority of one technique over the other. This is important because the literature shows that differences in clinical outcomes are greater in the first few months and tend to decrease over time [35; 36; 37; 38]. The evaluation of the three scores system was reported only at the final follow-up, which may have influenced the statistical significance of the results and the complication rate for the two procedures. In fact, no complications were reported in our series of patients. Prospective randomized studies with larger sample sizes and a more structured follow-up are needed to confirm these findings and further investigate the differences between the two treatment approaches. Nevertheless, this study's strength consists of the complete evaluation of all enrolled patients and the stratification of these patients into subgroups according to the location, type of fracture, and type of treatment. This detailed approach enhances the robustness of the long-term comparative data. Future Perspectives  
Future prospects in the treatment of distal radius fractures are strongly focused on treatment personalization and clinical research. The adoption of individualized therapeutic algorithms, based on the specific characteristics of the patient and the type of fracture, will enable the optimization of clinical outcomes by tailoring the treatment to each patient's unique needs. This personalized approach could reduce complications and enhance functional recovery. At the same time, the importance of randomized controlled clinical trials is crucial for comparing the effectiveness of various surgical and conservative techniques, contributing to the development of evidence-based protocols. These studies, with larger sample sizes and structured follow-up, will provide a solid foundation for increasingly targeted and scientifically validated management of distal radius fractures.