Delays to fracture stabilization and the effect on postoperative outcomes: A retrospective cohort study of 211 canine humeral condylar fractures

OBJECTIVE: To investigate the effect of surgical delay on radiographic and patient outcomes following canine humeral condylar fracture stabilization. STUDY DESIGN: Retrospective observational cohort study. SAMPLE POPULATION: A total of 211humeral condylar fractures (204 dogs). METHODS: Time to surgery and clinical data were collected from the medical record. Immediate postoperative radiographs were reviewed for an intracondylar gap or articular step defect. Postoperative complications and short-term outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis modeled radiographic and patient outcomes. RESULTS: Fracture events occurring on Friday or Saturday were systematically associated with longer delays to surgery (p < .001). Increasing delays to surgery were associated with an increased risk of an intracondylar gap or articular step defect on immediate postoperative radiographs (adjusted OR = 3.86 per additional day, 95% CI: 2.04-7.29, p < .001). Presence of an intracondylar gap or articular step defect was associated with an increased risk of postoperative complications (adjusted OR = 5.92, 95% CI: 1.44-24.36, p = .01). Presence of an intracondylar gap or articular step defect was associated with an increased risk of a poorer short-term outcome (adjusted OR = 0.13, 95% CI: 0.04-0.42, p = .001). The presence of postoperative complications increased the risk of a poorer short-term outcome (adjusted OR = 0.38, 95% CI: 0.17-0.87, p = .02). CONCLUSION: Delays to surgery are an important system-level factor influencing the accuracy of fracture reduction, postoperative complications, and short-term outcomes in canine humeral condylar fracture repair. CLINICAL SIGNIFICANCE: System-level optimization may be an avenue for quality improvement in this patient population.