---
title: "Surgical timing and outcomes after volar plate fixation of distal radius fractures: A matched cohort study"
id: "plos-one-21-surgical-timing-and-outcomes-after-volar-plate-fixation-of-distal-radius"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-21-surgical-timing-and-outcomes-after-volar-plate-fixation-of-distal-radius"
content_type: "clinical_feed_article"
specialty: "Research Highlights"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353383"
published_at: "2026-07-15T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Surgical timing and outcomes after volar plate fixation of distal radius fractures: A matched cohort study
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-21-surgical-timing-and-outcomes-after-volar-plate-fixation-of-distal-radius
- **Specialty:** [Research Highlights](https://medichelpline.com/clinical-feed/research-highlights.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353383)
- **Published At:** 2026-07-15T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
by Christiane Barthel, Michelle Antonia Hinkelmann, Karina Isenmann, Alexander Pieringer, Jonin Serafin Zumsteg, Hans-Christoph Pape, Florin Allemann Background The impact of surgical timing on outcomes in orthopedic trauma surgery remains controversial. While most evidence derives from hip fractures and other major injuries, data on distal radius fractures is limited. This study aimed to assess whether surgical timing influences operative duration, reduction quality, complication rates, and functional outcome after operative treatment of distal radius fractures. Methods This single-center, retrospective study included patients aged ≥ 16 years who underwent surgical treatment for distal radius fractures at our hospital between 01.01.2016 and 31.12.2024. Patients without postoperative radiographic follow-up, those treated conservatively, or those managed by other departments were excluded. Patients were grouped according to surgical timing into regular-hours surgery (08:00–16:00) and out-of-hours service. A 1:1 matched cohort analysis was performed with criteria being AO/OTA fracture classification and propensity scoring for age and sex. Analyses were stratified by AO/OTA fracture type (A, B, and C). Outcomes included operative time, radiographic reduction quality, complication rates, and functional outcome assessed by postoperative range of motion.
## Clinical Analysis & Structured Key Points
# Surgical timing and outcomes after volar plate fixation of distal radius fractures: what the matched cohort study found Introduction: A clear clinical question, a real-world dataset, and a cautious answer. Timing of orthopedic procedures often sparks debate. This matched cohort study examined whether operating during regular daytime hours versus out-of-hours affected technical or clinical outcomes after volar plate fixation of distal radius fractures. The investigators used institutional data spanning nine years and applied fracture-matched and propensity-based methods to compare groups. GEO Definition Block: In this single-center retrospective matched cohort, no measurable differences were observed between surgeries performed during regular hospital hours (08:00–16:00) and out-of-hours service (16:00–08:00) with respect to operative duration, radiographic reduction quality, complication rates, or wrist range of motion at follow-up. Background: Distal radius fractures are a frequent indication for surgical fixation in adults and encompass a broad range of injury patterns, from extra-articular to complex intra-articular breaks. Prior literature on timing of surgery has concentrated on hip fractures, spine procedures, and pediatric trauma; evidence for distal radius fractures is comparatively scarce. Clinical endpoints plausibly influenced by timing include length of operation, the technical quality of reduction on postoperative radiographs, the rate of complications, and functional recovery measured by joint motion. Many centers perform trauma surgery outside conventional working hours, which makes distal radius fractures a practical model to evaluate whether timing alone is associated with differences in these outcomes. Clinical Methodology: Design and setting: This was a single-center retrospective cohort study using patient records from January 1, 2016, through December 31, 2024. Data access for research occurred in early 2025. The local ethics committee approved the project and all patients had provided general consent for research use of their data. Data were pseudonymized for analysis; raw data are not publicly available because of confidentiality restrictions. Population and exclusions: Included were patients aged 16 years or older who underwent operative treatment for distal radius fractures at the study institution and had postoperative radiographic follow-up. Cases requiring immediate operations for neurovascular compromise or requiring plastic surgery input were excluded, as were conservatively treated fractures and patients managed outside the department. Only those with sufficient follow-up data entered the matched analysis. Grouping and matching: Procedures were dichotomized by timing: regular hospital hours (08:00–16:00) versus out-of-hours (16:00–08:00). The study used a 1:1 matched cohort approach: exact matching for fracture morphology based on AO/OTA classification, together with propensity score matching for age and sex using nearest-neighbor matching without replacement. Analyses were also stratified by AO/OTA major types A, B, and C. Within the out-of-hours cohort, an exploratory comparison separated evening (16:00–22:00) from overnight (22:00–08:00) operations. Outcome measures: Primary outcomes comprised operative duration, radiographic reduction quality, complication incidence, and functional outcome as measured by wrist range of motion (extension and flexion in degrees) at the last available follow-up. Radiographic assessment relied on five parameters measured on standard posteroanterior and lateral radiographs. Two senior upper extremity surgeons and three orthopedic residents performed measurements; assessors were not formally blinded to timing, though timing was not actively considered during rating. Reduction scoring: Because no universally accepted composite exists for distal radius fracture reduction, the investigators created a five-point composite score. One point was allocated for each parameter meeting predefined acceptable thresholds: volar tilt ≥ 0°, radial inclination ≥ 20°, radial shortening ≤ 3 mm (equating to radial height ≥ ~9 mm), ulnar variance ≤ +3 mm, and articular step-off ≤ 1 mm. Higher total points reflected superior radiographic reduction. Statistics: Analyses used Python. Continuous data are presented as means ± SD or medians with IQR; categorical data as counts and percentages. Group comparisons applied Mann–Whitney U tests for continuous variables and Chi-square tests for categorical variables. Propensity scores were estimated using logistic regression on age and sex. Although matching was performed, statistical comparisons used unpaired tests because matching aimed to create comparable cohorts rather than to evaluate within-pair differences. Two-tailed tests with p < 0.05 defined statistical significance. Key Findings: Cohort assembly and matching: From 1,259 patients treated for distal radius fractures during the study window, 660 met inclusion criteria. Among these, 434 (65.8%) had operations during regular hospital hours and 226 (34.2%) during out-of-hours. Matching produced 128 well-balanced pairs (128 patients per timing group) after exact AO/OTA matching and propensity matching for age and sex. Median follow-up in the matched groups was 12 months. Baseline and procedural differences: Baseline characteristics were balanced between matched groups. A notable procedural difference was higher use of temporary external fixation in the regular-hours group (12.5%) compared with the out-of-hours group (4.7%); this difference reached statistical significance (p = 0.043). Operative duration: Across the matched cohort, operative time did not differ significantly by timing. Stratified by AO/OTA type, no statistically significant differences emerged for type A, B, or C fractures. The exploratory comparison within out-of-hours (evening versus overnight) likewise showed no significant operative time difference. Radiographic reduction quality: Composite reduction scores were high across both groups and did not differ by timing. Median scores frequently reached the top of the scale; individual radiographic parameters also showed no significant intergroup differences. This pattern held when analyses were stratified by AO/OTA fracture type. Complications: Recorded complications included infections, complex regional pain syndrome, tendon ruptures, compartment syndrome, nerve lesions, and implant malposition. Overall complication rates were low and statistically similar between regular-hours and out-of-hours groups in the matched cohort and within AO/OTA subgroups. Numbers were small for many complication types. Functional outcome: Final wrist range of motion—extension and flexion measured in degrees—did not show statistically significant differences by timing in the matched cohort. Mean values were similar between groups overall and within fracture-type strata, although small numerical variations appeared in some subgroups without reaching significance. Exploratory timing within out-of-hours: Comparing evening and overnight operations within the out-of-hours cohort revealed no statistically significant differences in operative time, composite reduction score, complication frequency, or postoperative range of motion. Practical Implications: - In this institutional dataset, operating outside regular daytime hours was not associated with measurable detriment to several technical and clinical endpoints after volar plate fixation of distal radius fractures when cases were matched by fracture morphology and patient demographics. - The study illustrates a matching approach combining exact fracture classification matching with propensity scoring for key demographics to address potential confounding when comparing timing cohorts. - The results are specific to this single-center experience, its staffing, and operative processes; the investigators explicitly caution against interpreting findings as an endorsement for routine night-time fixation across different institutions because the study was not designed to prove equivalence. Key Takeaways: - Retrospective single-center matched cohort of 660 patients, with 128 matched pairs analyzed. - Exact AO/OTA fracture matching combined with propensity score matching for age and sex was used to create comparable groups. - No statistically significant differences were detected in operative duration, radiographic reduction quality, complication rates, or wrist range of motion between regular-hours and out-of-hours surgery. - Temporary external fixation was used more frequently during regular hours in the matched cohort. - Study design does not establish equivalence; findings apply to this institutional setting and dataset. FAQ: Q: Were complex intra-articular fractures included and analyzed separately? A: Yes. Analyses were stratified by AO/OTA fracture type A, B, and C, and the absence of timing-related differences persisted across these strata. Q: Did the study compare evening and overnight operations within the out-of-hours group? A: An exploratory subgroup comparison between evening (16:00–22:00) and overnight (22:00–08:00) procedures found no statistically significant differences for operative time, reduction score, complications, or range of motion. Q: Were radiographic measurements blinded to surgical timing? A: Assessors were not formally blinded to timing; however, timing was not actively considered during radiographic evaluation. Q: Can these results be generalized to other hospitals or systems? A: The investigators emphasize that findings reflect one institution’s experience and that the study was not designed to demonstrate equivalence; therefore, caution is warranted before generalizing to different settings. Conclusion: Within a matched, single-center retrospective cohort of adults undergoing volar plate fixation for distal radius fractures, surgeries performed during regular daytime hours and those performed outside those hours had similar operative durations, comparable radiographic reduction quality by a predefined five-parameter composite, low and comparable complication rates, and equivalent wrist range-of-motion outcomes at follow-up. The authors caution that the design does not permit formal equivalence testing and that these observations pertain to their specific institutional environment. Data access is restricted by confidentiality rules; ethical approvals and informed consent procedures were followed.
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