Title : Compliance with the BOAST Guidance in the management of distal radius fractures: A single-centre audit
Abstract:
Introduction: Distal radius fractures are among the most common orthopaedic injury presenting to emergency departments. The British Orthopaedic Association Standards for Trauma (BOAST) have defined standards for their assessment and management. This audit aimed to determine compliance of local practice at a district general hospital with key BOAST standards, focussing on: standard 4, fracture clinic review within 72 hours of injury, standard 9, fractures with volar angulation should be considered for fixation, and standard 11, intra-articular fractures should be operated on within 72 hours from injury.
Methods: The audit was registered with the local audit department. Fifty patients presenting with distal radius fractures in March to April 2026 were identified using electronic patient record systems. Details pertaining to time from attendance to Virtual Fracture Clinic (VFC), face-to-face clinic, radiographic features, management, and time to surgery were recorded. Two patients were excluded from the fracture analysis as they did not have a bony injury. Microsoft Excel was used for the data analysis.
Results: Out of the 48 fractures, 38 (79%) and 10 (21%) were intra-articular and extra-articular respectively. 11 (23%) were managed operatively and 37 (77%) conservatively. All operative cases were intra-articular fractures. Compliance with the timing of VFC review was 97.9% (46/47) (standard 4). All five (100%) volar fractures were considered for fixation (standard 9). For surgical timing, none of the intra-articular fracture were operated on within 72 hours of injury (0%), with the median time being 13 days (range 5-43) (standard 11).
Conclusion: This audit demonstrated excellent adherence of fracture clinic review through the VFC pathway, and operative decision-making to the BOAST guidance. However, the audit captured that no intra-articular fractures which required fixation were operated within 72 hours of injury. A proposal of providing an additional hand trauma list with a subsequent re-audit is required.
