Casting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment.

However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age.

We examine how chronologic age compares with measures of physiologic age in DRF treatment recovery.

This retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022.

WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016.

Participants selected casting or surgery. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation.

Participants were stratified by chronologic age, number of comorbidities, and activity status.