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Objectives and questions: Distal radius fractures are the most common upper limb fractures globally. Management depends on injury characteristics & patient factors,with non-operative treatment typically involving below-elbow casting & operative management most commonly involves open reduction and internal fixation (ORIF) using volar plating, often supplemented by short-term postoperative immobilisation where fixation or bone quality is a concern. This study evaluates postoperative outcomes in patients undergoing ORIF who experienced prolonged casting (>14 days) in the perioperative period.

Material and methods: This retrospective cohort study was conducted at Epsom and St Helier Hospital UK. 150 patients who underwent volar plate fixation for distal radius fractures between July 2024 and December 2025 were included. Patient demographics, fracture characteristics, and operative details were extracted from electronic medical records. Postoperative outcomes, specifically stiffness was assessed using clinic documentation at 3-month follow-up.

Results: 54 patients (36%) demonstrated postoperative stiffness and swelling at 3 months. Prolonged casting (>14 days), either preoperatively due to atrial of non-operative management and/or surgical delay, or postoperatively due to plaster immobilisation, was the most consistently identified factor associated with these outcomes. No consistent association was identified with fracture pattern, patient comorbidities, tourniquet time, operating surgeongrade, or implant type.

Discussion and conclusions: NHS England estimates OPD follow-up costs at £125–£150 per visit, excluding investigations. Prolonged casting may delay early mobilisation,contributing to stiffness & increased follow-up requirements, with functional and financial implications. Our study findings support timely surgical fixation inline with BOAST guidance and advocate early postoperative mobilisation without routine casting to improve outcomes & reduce healthcare burden.