Radiographic outcomes decline linearly with increased time to surgery in distal radius fractures: A cohort analysis.

Introduction: The optimal timing for distal radial fracture fixation remains controversial. Most previous studies have dichotomized timing into early or delayed categories, potentially obscuring the true effect of delay. This study investigated surgical timing as a continuous variable to determine its influence on radiographic alignment.

Methods: In a retrospective multicentre cohort study, we reviewed 691 surgically treated distal radial fractures across four Swedish hospitals. Radiographic parameters assessed included dorsal tilt (primary outcome), radial inclination, ulnar variance, intra-articular step, coronal shift and anterior apposition. Logistic regression was used to analyse overall acceptable alignment, while linear regression was used for dorsal tilt. Models were adjusted for age and sex. Interobserver reliability was evaluated with intraclass correlation coefficients.

Results: The mean patient age was 61 years, and 80% of the cohort were female. Each additional day delay to surgery increased the risk of unacceptable alignment by 6%, corresponding to a twofold risk increase with a 2 week delay. Dorsal tilt worsened linearly by approximately 0.34° per day, accumulating to nearly 5° after 2 weeks. Male sex was associated with significantly greater dorsal tilt (mean difference >2°) and reduced correction compared with females. Interclass correlation coefficients demonstrated excellent reliability for dorsal tilt (0.952) and radial inclination (0.947), and moderate reliability for ulnar variance (0.748) and coronal shift (0.611).

Conclusion: A linear relationship was identified between surgical delay and declining radiographic outcomes, highlighting that each day's delay progressively compromises fracture alignment. These findings emphasize the importance of prompt surgical intervention for distal radial fractures to achieve optimal radiographic results.

Level of evidence: III.