252 orthopaedic surgeons from various countries participated in a web-based randomized study investigating the impact of surgeon, patient, and radiographic factors on the recommendation for surgery in cases of distal radius fracture. Surgeons were randomized to receive both radiographs and clinical information, or to receive radiographs only. Based on the information given, the surgeons were asked to give their recommendation for surgery or not. Regardless of the group, surgery was recommended 52% of the time. Agreement was lower among surgeons supplied with clinical information. Radiographic factors were most influential in the recommendation for surgery.