Association Between Surgical Timing and Clinical Outcomes in Elbow Fracture Management

Background Elbow fractures, including distal humerus, radial head and neck, and olecranon injuries, pose significant surgical challenges due to complex anatomy and the high risk of postoperative stiffness. Early fixation has been advocated to restore alignment and enable early mobilization, but concerns regarding soft tissue readiness and patient optimization often delay intervention. The 48-hour threshold for surgical timing was selected based on biological reasoning-intervening during the early inflammatory phase to minimize periarticular fibrosis-and logistical feasibility within tertiary-care systems, where this window allows adequate preoperative preparation and resource allocation. This study aimed to evaluate the effect of early (<48 hours) and delayed (48 hours-14 days) surgical fixation on functional outcomes and postoperative complications following elbow fractures. Methods This prospective observational study included patients aged 12 years and above who presented with acute distal humerus, radial head or neck, or olecranon fractures within 14 days of injury. Only closed or Gustilo-Anderson type I open fractures were included. Patients were classified into early (<48 hours) and delayed (48 hours-14 days) surgery groups. The reasons for surgical delay, medical, logistical, or soft-tissue related, were documented. Functional recovery was assessed using the Mayo Elbow Performance Score (MEPS) at six months, and postoperative complications were recorded. Statistical analysis included t-tests, chi-square or Fisher's exact tests, and multivariable logistic regression to identify independent predictors of adverse outcomes. A subgroup analysis compared adolescents (12-17 years) and adults (≥18 years) to explore age-related differences in functional recovery and healing. A p-value of <0.05 was considered statistically significant. Results Of 177 patients (91 early, 86 delayed surgery), baseline characteristics and fracture patterns were comparable between groups. Early surgery was associated with shorter operative duration (94.5 ± 28.9 vs. 102.7 ± 32.9 minutes, p = 0.004), reduced intraoperative blood loss, and shorter hospital stay (4.8 ± 1.2 vs. 6.1 ± 1.4 days, p < 0.001). The overall complication rate was lower in the early group (12.1% vs. 25.6%, p = 0.021). At six months, patients undergoing early fixation achieved significantly higher mean Mayo Elbow Performance Scores (MEPS) (87.2 ± 8.1 vs. 81.5 ± 9.6, p < 0.001) and a greater proportion of excellent/good functional outcomes (86.8% vs. 72.1%, p = 0.019). Multivariable logistic regression, adjusted for potential confounders such as comorbidities, mechanism of injury, delay cause, and rehabilitation initiation, identified early surgery as an independent predictor of optimal functional recovery (MEPS ≥ 90). Conclusion Early surgical intervention for elbow fractures, particularly within 24-48 hours of injury, was associated with significantly better functional outcomes, reduced postoperative stiffness, and shorter rehabilitation time compared to delayed surgery. Although overall complication rates did not differ significantly, the early surgery group demonstrated lower incidences of infection and transient neuropraxia, supporting the clinical benefit of timely fixation. These findings underscore the importance of prioritizing early operative management in suitable candidates to optimize recovery, minimize functional impairment, and enhance long-term joint outcomes.