Raja Muhammad Mussab
Introduction
Distal radius fractures are the most common upper limb fractures globally. Management depends on injury characteristics & patient factors, with nonoperative treatment typically involving below-elbow casting & operative management most commonly involves open reduction and internal fixation (ORIF) using volar plating, often supplemented by short-term postoperative immobilisation where fixation or bone quality is a concern. This study evaluates postoperative outcomes in patients undergoing ORIF who experienced
prolonged casting (>10 days) in the pre- or post-operative period.
Methods
This retrospective cohort study was conducted at Epsom and St Helier Hospital UK.150 patients who underwent volar plate fixation for distal radius fractures between July 2024 and December 2025 were included. Patient demographics, fracture characteristics, and operative details were extracted from electronic
medical records. Postoperative outcomes, specifically stiffness was assessed using clinic documentation at 3-month follow-up.
Results
54 patients (36%) demonstrated postoperative stiffness and swelling at 3 months. Prolonged casting (>10 days), either preoperatively due to a trial of non-operative management and/or surgical delay, or postoperatively due to plaster immobilisation, was the most consistently identified factor associated with these outcomes. No consistent association was identified with fracture pattern, patient comorbidities, tourniquet time, operating surgeon grade, or implant type.
Conclusions
NHS England estimates OPD follow-up costs at £125–£150 per visit, excluding investigations. Prolonged casting may delay early mobilisation, contributing to stiffness & increased follow-up requirements, with functional & financial implications. Our Study findings support timely surgical fixation in line with BOAST guidance & advocate early postoperative mobilisation without routine casting to improve outcomes & reduce healthcare burden
Authors
Raja Mussab, Epsom and St Helier University Hospital, London, United Kingdom & Russell Hall Hospital, Dudley, United Kingdom
Alexandra Manoliu, Komalpreet Kaur, Youssef Ghazouli, Najab Ellahee
Epsom and St Helier University Hospital, London, United Kingdom