Socioeconomic status does not change decision-making in the treatment of distal radius fractures at a level 1 trauma center

OTA Int. 2022 Nov 16;5(4):e221. doi: 10.1097/OI9.0000000000000221. eCollection 2022 Dec.


Objectives: To compare operative rates, total hospital charges, and length of stay between different socioeconomic cohorts in treating distal radius fractures (DRFs).

Design: A retrospective cohort study.

Setting: Large public level 1 trauma center.

Patients: A retrospective search of all trauma activations over a 7-year period (2013-2020) yielded 816 adult patients diagnosed with DRF. Patients were separated into cohorts of socioeconomic status based on 2010 US Census data and insurance status.

Intervention: DRFs were treated either nonoperatively using closed reduction and splinting or operatively using open reduction and internal fixation, closed reduction percutaneous pinning, or external fixator application.

Main outcome measurements: Operative rates of DRF, total hospital charges, and length of stay.

Results: Patients who were uninsured or in the low-income socioeconomic cohort had no significant difference in operative rates, total hospital costs, or length of stay when compared with their respective insured or standard income groups. Younger patients and those with OTA/AO type C, bilateral, or open DRFs were more likely to undergo operative intervention.

Conclusions: This study demonstrates that low socioeconomic status based on annual household income and insurance status was not associated with differences in operative rates on DRFs, length of stay, or total hospital charges. These results suggest that outcome disparities between groups may be caused by postoperative differences rather than treatment decision-making. Although this study investigates access to surgical care at a publicly funded level 1 trauma center, disparities may still exist in other models of care.

Level of evidence: Prognostic Level III.

Keywords: cost; distal radius; fracture; insurance; open reduction internal fixation; socioeconomic.