Objective  To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated distal radius fractures in patients aged 55 and above, and to secondarily report differences in demographics, geographical variation, and utilization costs of patients requiring subsequent malunion correction. Methods  We identified patients aged 55 and above who underwent nonoperative treatment for a distal radius fracture between 2007 and 2016 using the IBM MarketScan database. In the nonoperative cohort, we identified patients who underwent malunion correction between 3 months and 1 year after distal radius fracture. The primary outcome was rate of malunion correction. Multivariable logistic regression controlling for sex, region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics, geographical variation, and utilization cost. Results  The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion, controlling for sex, region, and ECI (odds ratio = 0.94 [0.93-0.95]; p  < 0.01). The southern United States had the highest percentage of patients initially managed operatively (30.7%), the Northeast had the lowest (22.0%). Patients who required a malunion procedure incurred higher costs compared with patients who did not ($7,272 ± 8,090 vs. $2,209 ± 5,940; p  < 0.01). Conclusion  The rate of surgery for symptomatic malunion after initial nonoperative treatment for distal radius fractures in patients aged 55 and above is low. As younger and healthier patients are more likely to undergo malunion correction with higher associated costs, surgeons may consider offering this cohort surgical treatment initially.

BACKGROUND: The dissemination of research and evidence-based medicine is critical to advancing science and improving clinical practice. The purpose of this study was to evaluate the timing and associated factors of the publication process for the most influential orthopaedic surgery research journals. METHODS: After analyzing 25 orthopaedic surgery journals with the highest impact factors, 14 journals provided the necessary information for data analysis. A minimum of three consecutive issues per journal from 2021 were collected for review. Within each issue, all articles were included except for reviews, commentaries, replies, letters to the editor, and invited articles. The publication times for received to accepted (RA), received to published in press (RP1), and received to published in print (RP2) were retrieved and compared. Journal impact factor, specialty, and article level of evidence were recorded. RESULTS: A total of 1040 articles were included with a mean number of 74.3 ± 38 (range, 35-182) articles analyzed per journal. The mean impact factor for the 14 journals was 3.6 ± 1 (range, 2.5-5.8). The overall median duration of time for RA, RP1, and RP2 were 119 (IQR, 78-165) days, 157 (IQR, 102-216) days, and 291 (IQR, 243-378) days across all 14 journals, respectively. Journal of Arthroplasty demonstrated the shortest median duration of time for RA and RP1, while International Orthopaedics demonstrated the shortest median duration of time for RP2. Clinical Journal of Sport Medicine demonstrated the longest median duration of time for RA and RP2, while the American Journal of Sports Medicine demonstrated the longest median duration of time for RP1. Level three studies, which included retrospective case-control and cohort study designs, demonstrated the shortest publication times, while sports medicine journals demonstrated the longest publication times for all periods. CONCLUSION: There was substantial variation in publication times across orthopaedic surgery journals which may impact accessibility to clinical insights.