Surgical timing and outcomes after volar plate fixation of distal radius fractures: A matched cohort study

The impact of surgical timing on outcomes in orthopedic trauma surgery remains controversial. While most evidence derives from hip fractures and other major injuries, data on distal radius fractures is limited. This study aimed to assess whether surgical timing influences operative duration, reduction quality, complication rates, and functional outcome after operative treatment of distal radius fractures.

This single-center, retrospective study included patients aged ≥ 16 years who underwent surgical treatment for distal radius fractures at our hospital between 01.01.2016 and 31.12.2024. Patients without postoperative radiographic follow-up, those treated conservatively, or those managed by other departments were excluded. Patients were grouped according to surgical timing into regular-hours surgery (08:00-16:00) and out-of-hours service. A 1:1 matched cohort analysis was performed with criteria being AO/OTA fracture classification and propensity scoring for age and sex. Analyses were stratified by AO/OTA fracture type (A, B, and C). Outcomes included operative time, radiographic reduction quality, complication rates, and functional outcome assessed by postoperative range of motion.

A total of 660 patients were included, of whom 434 underwent surgery during regular hospital hours and 226 during out-of-hours service. From the out-of-hours cohort, matching was performed using an exact match for fracture morphology according to the AO/OTA classification and propensity score matching for age and sex, resulting in two well-balanced 1:1 matched groups comprising 128 patients each. Across both groups, operative duration, reduction quality, complication rates, and functional outcome assessed by postoperative range of motion did not differ between regular-hours and out-of-hours surgery.

Surgical timing was not associated with differences in operative duration, reduction quality, complication rates, or functional outcome after operative treatment of distal radius fractures. Within this matched cohort, no measurable differences were detected between regular-hours and out-of-hours surgery. As the study was not designed to establish equivalence, these findings indicate the absence of a detectable difference in this specific institutional setting and should not be interpreted as support for routine out-of-hours fixation.