© 2017 Hanley & Belfus Study Design: A prospective cohort study. Introduction: Physical factors that predict hand dexterity and the recovery of hand dexterity after a distal radius fracture (DRF) have not yet been examined. Purpose of the Study: The first objective was to evaluate the recovery of hand dexterity comparing the injured and uninjured hands during the year after a DRF. The second objective was to determine the effect of age and sex on hand dexterity of the injured hand. Methods: Hand dexterity was examined bilaterally for the manipulation of 3 different sized objects (small, medium, and large) using the NK hand dexterity test. The measurements took place at 3, 6, and 12 months after DRF. Generalized linear modeling was performed, with age and sex as covariates, to assess changes over time, and between sides. Results: Overall, 242 patients with DRF (45 males and 197 females) with a mean age of 60.2 years with SD of 11.26, participated in the study. Statistical differences in hand dexterity were found between the injured and uninjured hands across all time intervals (P <.001). The effect size for the deficit between the injured and uninjured hands decreased across the time intervals and ranged from 0.19 to 0.38 for large objects, from 0.17 to 0.25 for medium objects, and from 0.11 to 0.32 for small objects. For each 1-year increase in age, hand dexterity scores were 0.3-0.4 seconds slower. Sex had much less effect, with annual increases of 0.1 seconds in hand dexterity scores. Conclusions: Scores on the NK dexterity test improved between 3 and 6 months and then worsened between 6 and 12 months; at no point did dexterity equal the uninjured side. Greater attention to measuring and treating dexterity may be needed to provide a complete recovery after DRF. Scores will be affected by age and sex. Level of Evidence: Prognosis, 2a.