Dedicated Upper Extremity Trauma List for Closed Distal Radius Fractures Improves Surgical Efficiency and Reduces Costs

Introduction: The operative treatment of closed distal radius fractures has traditionally been managed through trauma waiting lists, resulting in the planning of add-on cases after urgent trauma or elective surgery. We investigated the feasibility of a once-weekly dedicated operating list for the treatment of semi-elective upper extremity fractures and assessed the effects on costs and operative time. Methods: A retrospective analysis was performed comparing consecutive periods before and after the introduction of a dedicated upper extremity trauma list at a Level I trauma center. The preimplementation period extended from January 2024 to August 2024, and the postimplementation period from September 2024 to March 2025. The dedicated operating list was run once-weekly and used to schedule the surgical treatment of isolated closed distal radius fractures and clavicle fractures. Closed distal radius fractures that required open reduction and internal fixation (ORIF) via volar plate osteosynthesis accounted for the highest caseload and were reviewed for the purpose of this study. Exclusion criteria were age <18 years, fractures managed through a dorsal approach, associated ligamentous injury, inability to ambulate, and referral >14 days after the date of injury. The operating list was established to facilitate a standardized workflow managed by a dedicated surgical team responsible for treating these fractures on a weekly basis. The consecutive patient cohort from the postimplementation period was compared with a consecutive cohort from the preimplementation period. The following data were collected from the health records: surgical and operating room time per case, procedure- and admission-related costs, time to treatment, hospital stay, and complications and reoperations at the 90-day mark. Results: The nondedicated cohort comprised a total of 143 patients that were treated during the preimplementation period. The dedicated cohort comprised 104 consecutive patients treated during the postimplementation period. After introduction of the dedicated upper extremity trauma list, the median surgical time per case was reduced by 51%, from 79 min (range 27–193) to 39 min (range 23–93) (p < 0.01). The quartile deviation of surgical time in the nondedicated and dedicated cohorts decreased from 23 to 7 min, respectively (p < 0.001). The median total cost per case decreased by 29% (p < 0.01). The median time to treatment increased from 2 days to 5 days after implementation of the dedicated list (p <0.001). The complication rates at 90 days in the nondedicated and dedicated cohorts were 9.4% and 7.7%, respectively (p = 0.82). The reoperation rates at 90 days were 4.3% and 1.9%, respectively (p = 0.47). Conclusion: A dedicated upper extremity trauma list, run once-weekly by a specialized team, significantly improves time and cost efficiency in volar locked plating of isolated, closed distal radius fractures. Summary: This retrospective study evaluated the feasibility and outcomes of introducing a dedicated weekly upper extremity trauma list at a Level I trauma center. A cohort of 143 consecutive patients who underwent volar locked plating of the distal radius in the preimplementation period was compared to a cohort of 104 patients in the postimplementation period. The median surgical time per case, operating room time and overall case time were significantly reduced by 51%, 49% and 38%, respectively, after implementation of the dedicated operating list. The median total cost per case was reduced by 29%. No statistically significant differences in complications and reoperations were observed between the dedicated and nondedicated cohorts at 90-day follow-up; however, noninferiority could not be established.