Timely Fixation of Distal Radius Fractures: Improving Compliance With National Institute for Health and Care Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) Guidelines

Background Distal radius fractures are among the most common orthopaedic injuries, accounting for 8-15% of all adult fractures. Timely fixation reduces complications and improves outcomes. National guidelines recommend fixation within 72 hours for intra-articular and within 7 days for extra-articular fractures. This closed-loop audit evaluated compliance with these targets and the impact of targeted service level interventions between audit cycles. Methods A retrospective two-cycle clinical audit was performed at a tertiary trauma centre. The first cycle (March-July 2024) and second cycle (January-April 2025) included all adult patients (>18 years) with a radiologically confirmed distal radius fracture, treated operatively with Open Reduction Internal Fixation or Closed Reduction and Percutaneous Pinning. Data on the timing of injury and surgery were compared against standards based on national guidelines. Interventions between cycles included the appointment of a hand consultant and the creation of a dedicated Thursday trauma list to ensure improved compliance. Statistical comparisons were made using Chi-squared testing (statistical significance set at p < 0.05). Results Cycle 1 evaluated 65 patients (42 intra-articular, 23 extra-articular), while cycle 2 included 74 patients (55 intra-articular, 19 extra-articular). For intra-articular fractures, compliance with the 72-hour surgery threshold improved from 33% to 42%. For extra-articular fractures, the compliance with the 7-day cut-off period for surgery improved from 48% to 63%. Overall mean time to fixation reduced from 6.7 ± 3.7 days to 5.3 ± 2.8 days (<i>p</i> = 0.03). Conclusion Targeted service reorganization, including improved compliance with national guidelines for timely fixation of distal radius fractures. Sustained protected trauma capacity and streamlined booking processes are recommended to maintain progress.