Time to Surgery for Distal Radius Fractures: A Quality Improvement Audit

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Surgical Outcomes

Background:

• British Orthopedic Association Standards for Trauma (BOAST) advocate for early surgical intervention in distal radius fractures.
• Prioritization of intra-articular fractures over extra-articular ones is recommended to prevent complications like malunion.
• Delays in surgical management can increase complexity and negatively impact patient outcomes.

Purpose of the Study:

• To evaluate the impact of staff education and service changes on adherence to BOAST guidelines for distal radius fracture surgery.
• To assess operative timelines for both intra-articular and extra-articular distal radius fractures.
• To identify areas for improvement in the surgical care pathway for these fractures.

Main Methods:

• Retrospective analysis of 161 surgically managed distal radius fractures across three audit cycles.
• Interventions included staff education and adjustments to trauma lists.
• Data collected on demographics, injury type, and time to operative management (DOI and DOR).

Main Results:

• No statistically significant improvement in intra-articular fractures operated within three days of injury (DOI) or referral (DOR) post-intervention.
• A significant worsening and downward trend were observed in extra-articular fractures operated within seven days of injury (DOI).
• Extra-articular fractures operated within seven days of referral (DOR) remained relatively stable.

Conclusions:

• Staff education and service changes did not significantly improve timely treatment for intra-articular distal radius fractures.
• A concerning decline in timely surgical management for extra-articular fractures was noted, potentially due to late presentations or transfer delays.
• Routine education and further audits are recommended to sustain improvements in operative rates and fracture care pathways.