The Effect of Social Deprivation on Fracture-Healing and Patient-Reported Outcomes Following Intramedullary Nailing of Tibial Shaft Fractures

Abstract

Background:Social deprivation is a state marked by limited access to resources due to poverty, discrimination, or other marginalizing factors. We investigated the links between social deprivation and orthopaedic trauma, including patient-reported outcomes, radiographic healing, and complication rates following intramedullary nailing of tibial shaft fractures.Methods:We retrospectively reviewed 229 patients who underwent intramedullary nailing of tibial shaft fractures at our Level-I trauma center. The Area Deprivation Index (ADI), a validated proxy for social deprivation, was used to group patients into the most deprived tercile (MDT), the intermediate deprived tercile (IDT), and the least deprived tercile (LDT) for outcome comparison. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure the domains of Physical Function (PF), Pain Interference (PI), Anxiety, and Depression, and radiographic healing was assessed with the Radiographic Union Scale in Tibial fractures (RUST) system.Results:On univariate analyses, patients from the MDT reported worse PF, PI, Anxiety, and Depression scores than those from the LDT within the first year of postoperative follow-up. On multivariable regression analysis, PROMIS score outcomes were influenced by age, race, and smoking status, but not by social deprivation tercile. Furthermore, residing in the MDT was associated with a 31% increase in time to radiographic union compared with the LDT (β = 0.27; p = 0.01).Conclusions:Following intramedullary nailing of tibial shaft fractures, social deprivation is associated with slower fracture-healing and potentially influences short-term PROMIS scores. These results warrant further investigation in additional patient populations with orthopaedic trauma and highlight the importance of developing interventions to reduce inequities faced by patients from low-resource settings.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

“…14,25 These findings contribute to the growing body of evidence that demonstrates the significant impact of social determinants of health disparities on ankle fracture surgery, 7,8 and surgical fracture care more broadly. 9–14 However, it should be noted that rates of amputation, irrigation and debridement, and repeat ORIF were still quite low even in the homeless cohort. Therefore, until there is convincing evidence to support alternate treatment options for ankle fracture in this population, concerns regarding the risk of reoperation should not preclude surgical management in patients experiencing homelessness.…”

“…Baseline patient characteristics are shown in Table 1. When compared with nonhomeless patients, those in the homeless cohort were more likely to be male (59% vs. 34%, P , 0.001), have Medicaid insurance (30% vs. 9%, P , 0.001), and be younger in age (mean [SD] 5 48 [12] years vs. 57 [15] years, P , 0.001). Homeless patients also had significantly higher CCI scores (P , 0.001), with increased incidence of uncomplicated hypertension (P , 0.001), peripheral vascular disease (P 5 0.045), HIV (P , 0.001), and hepatitis C (P , 0.001).…”

“…Recent findings highlight the considerable impact of social determinants of health disparities on orthopedic trauma surgery. [7][8][9][10][11][12][13] However, to our knowledge, only one study has directly explored surgical outcomes in homeless patients with orthopedic trauma. 14 Given that musculoskeletal injury is a substantial cause of disability, understanding disparities in outcomes for homeless patients following surgical fracture care may help develop interventions that promote health equity.…”

The Effect of Social Deprivation on Hospital Utilization Following Distal Radius Fracture Treatment

“…SDoH have been shown to effect outcomes in several orthopedic subspecialties, including joint arthroplasty, upper extremity surgery, spine, trauma, and sports medicine. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Therefore, it is crucial for orthopedic surgeons to understand the connection that SDoH may have in predisposing patients to inferior outcomes following surgeries.…”

The Effect of Socioeconomic Deprivation on Radiographic Deformities in Children With Blount Disease

“…Higher ADIs represent more disadvantaged areas. While higher ADI has previously been linked to a number of orthopaedic health outcomes, 15–17 we are unaware of other studies that have focused on the associations of socioeconomic factors with the severity of Blount disease.…”