Clinical and injury-related factors associated with specific postoperative complications after surgical treatment of distal radius fractures: a retrospective observational study

With an ageing population and increased physical activity, distal radius fractures (DRF) are relatively common. Surgical treatment is becoming increasingly prevalent, yet postoperative complications including complex regional pain syndrome (CRPS), tendon irritation/rupture, carpal tunnel syndrome, internal fixation‑related discomfort, and non‑union/malunion significantly impact functional recovery and quality of life. Identifying associated risk factors is crucial for optimising treatment strategies.

To investigate the clinical and injury-related risk factors for specific postoperative complications in patients undergoing surgical treatment for distal radius fractures.

A retrospective observational study was conducted. Medical records of patients undergoing surgical treatment for DRF at our hospital between January 2022 and June 2025 were collected. Patients were categorised into a complication group and a non-complication group based on the occurrence of specific postoperative complications. Propensity score matching (PSM) was used to balance baseline differences, resulting in 60 cases per group. Primary outcomes comprised the incidence of specific postoperative complications and independent risk factors. Secondary outcomes included wrist range of motion, grip strength, and DASH (Disabilities of the Arm, Shoulder, and Hand) scores at 6 months postoperatively; injury-related factors [AO (Arbeitsgemeinschaft für Osteosynthesefragen) fracture classification, open fracture status, time from injury to surgery]; surgical factors (surgical approach, operative time, use of internal fixation); postoperative complications (diabetes mellitus, osteoporosis); postoperative management (immobilisation duration); and rehabilitation protocols. Univariate and multivariate logistic regression analyses were employed to identify risk factors.

After PSM, 60 cases and 60 controls were analysed. Among the 60 cases, the most common complication types were tendon irritation/rupture (31.7%) and internal fixation-related discomfort (23.3%), followed by carpal tunnel syndrome (20.0%) and CRPS (13.3%). Non-union/malunion occurred in 11.7% of cases. These proportions reflect the distribution of complication subtypes within the case group and do not represent population incidence rates. Multivariate analysis revealed that an operative time exceeding 90 min (OR = 4.006, 95% CI: 1.806–3.888) constituted an independent risk factor for postoperative complications (p < 0.05). Analysis of secondary outcomes revealed that the complication group exhibited significantly poorer wrist flexion/extension range of motion, percentage of grip strength recovery, and DASH scores at 6 months postoperatively compared to the non-complication group (p < 0.05). The incidence rates of all three major complications exhibited a significant increasing trend with higher fracture classification grades (p < 0.05). No statistically significant differences were observed between the complication and non-complication groups regarding gender, timing of surgery, approach selection, or type of internal fixation (p > 0.05).

The occurrence of specific complications following distal radius fracture surgery is closely associated with multiple factors, including surgical technique, injury severity, and postoperative management. The key finding is that operative time > 90 min was strongly associated with complications (OR 4.01), but this association likely reflects underlying case complexity rather than a direct causal effect. Fracture severity (AO-C) and early rehabilitation showed only associative patterns that were either confounded or bidirectional. Thus, the study’s primary contribution is to highlight the need for caution in interpreting operative time as a modifiable risk factor without adjusting for complexity, and to identify key unmeasured confounders for future research.