Clinical Outcomes and Guideline Adherence in Distal Radial Fractures with Associated Carpal Dislocations: A Service Evaluation.

BACKGROUND

Carpal dislocations are rare but serious injuries, sometimes occurring in isolation or in association with distal radial fractures. These complex injuries carry high risks of long-term dysfunction and require timely and standardised management. In 2017, the British Orthopaedic Association (BOA) and British Society for Surgery of the Hand (BSSH) published consensus guidelines to address wide variations in care and outcomes. This audit evaluated adherence to BOA/BSSH guidance at a tertiary trauma centre.

METHODS

80 patients with extra-articular distal radial fractures and carpal dislocations were retrospectively identified (October 2022-March 2023). A structured checklist based on BOA/BSSH recommendations was applied, focusing on documentation, anaesthesia, timing of surgery, immobilisation, and Postoperative care.

RESULTS

Mean age was 38.2 (±13.7) years, and 76/80 (95.0%) patients underwent surgical management. Only 4/37 (10.8%) patients with available anaesthesia data received intravenous regional anaesthesia as recommended. Mean immobilisation time was 8.2 (±2.6) weeks, exceeding the 4-week standard. Surgery within 1 week occurred in 34/76 (44.7%). No cases documented a neurovascular assessment. At 6 months, 22/80 (27.5%) reported ongoing stiffness and 40/80 (50.0%) required hand therapy.

CONCLUSION

Adherence to BOA/BSSH guidelines was poor, particularly for anaesthesia choice, immobilisation duration, and surgical timing. This may have contributed to mediocre outcomes. As current standards are primarily designed for DRFs rather than CDs, their direct application to these complex cases should be interpreted cautiously. Nonetheless, improved documentation, anaesthesia practice, and adherence to early mobilisation protocols represent clear opportunities for service improvement.