Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures

Purpose: To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). Methods: Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (t _surg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon–Mann–Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. Results: A t _surg > 48 h was associated with increased rate of delayed unions (t _surg < 48 h: 25% vs t _surg > 48 h: 59%, p = 0.03), but not complications (t _surg < 48 h: 44% vs t _surg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with t _surg > 48 h was also seen, but did not reach significance (t _surg < 48 h: 13.5 weeks vs t _surg > 48 h: 15.7 weeks, p = 0.11). Conclusion: A t _surg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. Level of evidence: Therapeutic Level III (Retrospective Cohort).