Medicaid and Indigent Patients Experience Delayed Fixation of Distal Radius Fractures, Resulting in Worse Consequential Radiographic Outcomes

• Published in: Orthopedics (Thorofare, N.J.) Vol. 47; no. 2; pp. e93 - e97
• Main Authors: Graphia, Cristina T, Klatman, Samuel H, Hein, Rachel E, Leonardi, Claudia, Zura, Robert D, Richard, Marc J
• Format: Journal Article
• Language: English
• Published: United States Slack, Inc 01.03.2024; SLACK INCORPORATED
• Subjects: Body mass index; Care and treatment; Complications and side effects; Diabetes; Evaluation; Evidence-based medicine; Fracture Fixation, Internal - methods; Fractures; Health care access; Hospital systems; Hospitals; Humans; Indigent care; Internal fixation in fractures; Louisiana; Medicaid; Orthopedics; Patient outcomes; Patients; Radiography; Radius; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Risk Factors; Surgeons; Surgery; Treatment Outcome; Wrist Fractures; United States; Louisiana
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20230616-04

Distal radius fractures are the most common upper extremity injury. Patients referred to safety-net tertiary facilities following a fracture experience significant delays in treatment because of financial and language barriers as well as poor access to care at outlying community hospitals. This delay in treatment can affect postoperative functional outcomes and complication rates because of failure to restore anatomic alignment. The purpose of this multicenter study was to assess for risk factors associated with delayed fixation of distal radius fractures and evaluate the impact of delayed treatment on radiographic alignment. Patients with a distal radius fracture treated surgically during a 2-year period were identified. Measures included time from injury to surgery, demographic information, fracture classification, and radiographic parameters. The effect of surgery delay on radiographic outcomes was assessed with delayed surgery defined as 11 or more days out from injury. A total of 183 patients met study inclusion criteria. Medicaid and indigent patients were more likely to experience a delay in surgical treatment. Specifically, 70% of these patients were treated in a delayed fashion. Delayed treatment of 11 days or more was associated with worse radial height and inclination on postoperative radiographic imaging. Medicaid and indigent patients are more likely to experience delayed fixation in the treatment of distal radius fractures. This delayed surgery negatively affects postoperative radiographic outcomes. These findings suggest a need to improve access to care for Medicaid and indigent patients and to proceed with operative intervention within 10 days for distal radius fractures. [ . 2024;47(2):e93-e97.].