Comparisons of Routine Initial Operative Fracture Treatment and Later Reconstructive Treatment are not Interesting

Studies that compare routine immediate operative treatment of fractures with selective later reconstructive surgery for malunion or nonunion may be misleading because it discounts the people who did well with nonoperative treatment. We identified 20 studies comparing routine operative fracture treatment and later reconstruction in the hip, clavicle, proximal humerus, elbow, and distal radius. Fifteen of 20 studies favored immediate operative treatment on the basis of lower reoperation rates, fewer complications, better patient reported outcome scores, and higher satisfaction. Five studies were neutral, and none favored delayed reconstruction for malunion or nonunion. These findings emphasize the potential benefits of routine early surgery and raise questions about the validity of studies comparing different timings of fracture treatment.