Surgical Delays After Wrist ORIF May Lower Outcome Scores

Yes, it's a chicken-or-egg thing, but the finding here still is both important and practical

What’s the Claim?

A systematic review of nearly 1200 patients treated surgically for distal radius fractures suggested that those with surgery performed before two weeks had better DASH scores than those whose surgery was delayed. The difference wasn’t just “statistically significant,” it also was quite large (mean DASH score of 4 versus 21). Although the study was large, complications and reoperations were sufficiently uncommon to result in underpowered between-group analyses of those endpoints, and no differences were found between early and later surgery in terms of complications or reoperations.

How’s It Stack Up?

The main reservation we have about this one is that not all of the source studies were designed to study surgical timing, and the authors extracted results about that question from studies on other topics. The likely effect of this is not unreliable data, just less data (and perhaps less-precise data) on the question of interest. In addition — and this is a caution that applies to essentially all research out there that seeks to link surgical delays to surgical outcomes — we have to disregard the title and all the language suggesting a cause-effect relationship. The main findings here likely were confounded by the fact that patients who were uncertain about surgery, who were infirm, or who otherwise were close calls on the medical clearance for surgery were in the delayed group, and factors like those also are associated with poorer surgical results. Those nonmodifiable factors may be driving the train.

What’s Our Take?