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.
Type of study/level of evidence
Therapeutic IV.
Key Words
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Article info
Publication history
Published online: March 06, 2023
Accepted:
December 14,
2022
Received:
September 14,
2020
Publication stage
In Press Corrected ProofFootnotes
S.K. and J.P. contributed equally to this manuscript.
No benefits in any form have been received or will be received related directly to this article.
Identification
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© 2023 by the American Society for Surgery of the Hand. All rights reserved.
