Distal radial fractures (DRFs) stand as a notable challenge in the realm of musculoskeletal injuries. Constituting approximately one sixth of emergently presenting fractures, DRFs have garnered significant attention from the medical community due to their impact on patients' lives and burden on the medical system [1], [2], [3]. Due to this large prevalence and impact on patients’ functional capacity, current management of DRFs is often multifactorial, incorporating patient goals, comorbidities, and fracture characteristics.

The age distribution of patients with DRFs is bimodal. Younger patients involved in high-energy accidents, such as sports-related injuries, constitute one group [4], [5], [6]. In contrast, older individuals with low bone density who sustain low-energy mechanisms of injury (MOIs), such as falls from standing height, comprise the other demographic [7,8]. Understanding specific risk factors and injury patterns prevalent in each group is essential for developing appropriate treatment guidelines.

Management of DRFs typically includes either non-operative immobilization or surgical fixation [9]. Although previous randomized controlled trials found no improvement in long-term patient reported outcomes following surgical fixation compared to non-operative treatment in patients over 65 years old, other studies have found opposing results, particularly in the short-term [10,11]. Currently, the American Academy of Orthopedic Surgeons recommends against operative management in these older patients, despite post-operative radiographic improvements [12]. While age represents a common proxy for functional status, a sole reliance on age can be hazardous as a patient's functional capacity is typically a constellation of various comorbidities. Studies have attempted to reconcile this by developing the 5-Item Modified Frailty Index (mFI-5). The mFI-5 assigns one point for each comorbidity (diabetes, hypertension requiring medication, dependent functional status, COPD, and CHF), in which a higher score indicates lower functional demand of the patient [13,14]. The mFI-5 has recently been shown to correlate with complication rates, reoperation rates, and readmission in older patients undergoing surgical fixation for DRFs [15,16]. However despite the impressive sample size of these studies, MOI has yet to be investigated as a potential contributor.

Herein, we utilize the National Trauma Data Bank (NTDB), the largest collection of US trauma data to date, to provide an updated incidence of emergently presenting DRFs. To the best of our knowledge, this represents the first time that demographics, comorbidities, including mFI-5, and MOI have been integrated on the national scale as potential risk factors for certain fracture characteristics. Additionally, we determine independent risk factors for increased length of stay and adverse, non-routine discharges.