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

The British Orthopedic Association Standards for Trauma (BOAST) recommend early surgery for distal radius fractures, giving priority to intra-articular fractures over extra-articular ones. Delays increase surgical complexity, risk of malunion, and poorer outcomes. Timely surgery improves results, resource use, and care pathways.

A retrospective analysis of patients undergoing surgical management of distal radius fractures was conducted over three months (from July to September 2023; n = 53 patients) at a regional hospital and compared with BOAST guidelines. Demographics, injury, and intervention data were recorded. Following staff education, a second cycle was undertaken (from April to June 2024; n = 57 patients). A third cycle (from October to December 2024; n = 51 patients) assessed the impact of our interventions on sustaining improvement. Time to operative management was measured by date of injury (DOI) and date of referral (DOR). Proportions of extra- or intra-articular fractures operated on within timelines were statistically assessed with either chi-square or Fisher's test, and trends were analyzed using Cochran-Armitage trend analyses.

In total, 161 operated distal radius fractures were analyzed. Following the introduction of staff education and changes to departmental trauma lists, there were nonsignificant improvements in intra-articular fractures operated on within three DOI across the three cycles (first: 59%, second: 56%, third: 75%; p = 0.2665; p(trend) = 0.1924). Extra-articular fractures operated within seven DOI worsened across the three cycles (first: 92%, second: 97%, third: 68%; p = 0.0119; p(trend) = 0.0243). Intra-articular fractures operated within three DOR had slight fluctuations (first: 74%, second: 68%, third: 88%; p = 0.1923; p(trend) = 0.1975). Extra-articular fractures operated within seven DOR remained stable (first: 92%, second: 100%, third: 89%; p = 0.1596; p(trend) = 0.8057).

Treatment of intra-articular distal radius fractures within three DOI or three DOR did not show statistically significant improvements following staff education and service changes. Improved identification and prioritization of intra-articular injuries was observed. In contrast, the proportion of extra-articular fractures operated on within seven DOI differed significantly between audit cycles and exhibited a significant downward trend. No other outcome showed a statistically significant difference or trend. The reduction in extra-articular fractures operated within seven DOI (68%) compared to seven DOR (89%) in the third audit cycle may be explained by patients presenting late or delays in transfers or referrals from peripheral hospitals. Implementation of routine education sessions regarding BOAST guidelines at staff turnover may contribute to improved operative rates within both cohorts. Further audit cycles are necessary to assess the continued impact of service changes on these operative timelines.