Effect of Time-To-Surgery on Distal Radius Fracture Outcomes: A Systematic Review

Purpose It remains unclear whether time-to-surgery for distal radius fractures affects clinical, functional, or radiographic outcomes or health care costs/use. This systematic review investigated the outcomes of early versus delayed surgery for closed, isolated distal radius fractures in adult patients. Methods A comprehensive search of MEDLINE, Embase, and CINAHL databases was completed for all original case series, observational studies, and randomized controlled trials reporting clinical outcomes of both early and delayed surgically-treated distal radius fractures from database inception to July 01, 2022. A consistent threshold of two weeks was used to define early versus delayed treatment arms. Results Nine studies, including 16 intervention arms and 1,189 patients (858 early, 331 delayed), were included. Mean age was 58 years (range, 33-76). At more than one year, the frequency-weighted mean Disabilities of the Arm, Shoulder, and Hand score was 4 in the early group (n = 208; range, 1-17) and 21 in the delayed group (n = 181; range, 4-27). Range of motion, grip strength, and radiographic outcomes were comparable. The pooled mean complication rate (7% vs 5%) and revision rate (3.6% vs 1%) were very low in both groups. Conclusions A delay in time-to-surgery greater than two weeks for distal radius fractures may be associated with inferior patient-reported outcomes. Early surgery was associated with improved long-term Disabilities of the Arm, Shoulder, and Hand scores. On the basis of the available evidence, range of motion, grip strength, and radiographic outcomes are similar. The complication and revision rates were very low in both groups and comparable. (J Hand Surg Am. 2023;48(5):435-443. Copyright & COPY; 2023 by the American Society for Surgery of the Type of study/level of evidence Therapeutic IV.