Surgical Timing, Fracture Complexity and Healthcare-System Factors in Operatively Managed Distal Radius Fractures: A Retrospective Cohort Study

Background/Objectives: Surgical timing after distal radius fracture remains debated, while healthcare-system contributors to delay are less well described. We evaluated associations between time to surgery, fracture complexity, healthcare-pathway factors and postoperative complications. Methods: This retrospective single-centre cohort study used data from a registered clinical audit at North Manchester General Hospital. Patients aged ≥16 years undergoing operative management of an acute distal radius fracture between 18 March 2024 and 13 May 2025 were included. The primary outcome was any documented postoperative complication. Logistic regression assessed injury-to-surgery interval while adjusting for age and AO/OTA fracture complexity. Results: Eighty-nine patients were included; mean age was 57.9 years, and 74.2% were female. Median injury-to-surgery interval was 16 days (IQR 7–22) and did not differ across AO/OTA A, B and C groups (p = 0.582). Service/capacity factors were documented in 47/89 patients (52.8%) and were associated with longer waits than cases with no documented delay (median 18 versus 7.5 days; p < 0.001). Thirteen patients experienced complications (14.6%) and six underwent reoperation (6.7%). Each additional seven days to surgery was not significantly associated with complications, after adjustment (aOR 1.25, 95% CI 0.84–1.87; p = 0.269). Conclusions: Documented service/capacity-related factors were common and associated with longer observed surgical intervals. No statistically significant association was detected between broad AO/OTA type and surgical timing or between timing and documented postoperative complications. These findings do not establish causation or equivalence between earlier and later surgery. Larger prospective studies should evaluate clinical prioritisation, pathway factors and patient-centred outcomes.