Association Between Insurance Status and Recommendation for Surgery for Distal Radius Fractures

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Purpose: Disparities continue to impact patient care within orthopedics. Distal radius fractures (DRFs) are extremely common, with variability in surgical indications allowing for potential treatment disparities. The study sought to determine whether (1) insurance status and (2) geographic socioeconomic disadvantage is associated with surgeon treatment recommendation for dorsally angulated DRF. Methods: This retrospective cohort study used institutional data from 2016 to 2021 to assess associations between patient demographics and socioeconomic variables of interest, including geographic socioeconomic disadvantage (Area Deprivation Index), insurance status, and likelihood of operative recommendation. Multivariable logistic regression adjusted for potential confounders including fracture severity based on degree of dorsal angulation (mild, ≥0° and ≤10°; moderate, >10° and <20°; severe ≥20°), radial inclination, ulnar variance, presence of an ulnar styloid fracture, sex, age, and Elixhauser Comorbidity score (α = 0.05). Results: In total, 891 patients were included, with a mean age of 55 years (range 18-62), 78% women (n = 699), and 79.4% White non-Hispanic (n = 707), 2.9% Black non-Hispanic (n = 26), 6.9% Hispanic (n = 61), and 10.9% Other (n = 97). In total, 31% (n=280) of all patients presented with mild DRF, 29% (n = 258) moderate, and 40% (n = 353) severe. Overall, 77% (n = 688) of patients were recommended surgery, and 74% (n = 660) underwent operative management. Public health insurance was associated with lower likelihood of recommendation for surgery. There was no significant difference in treatment recommendation based on Area Deprivation Index. Conclusions: Public health insurance was found to be significantly associated with lower likelihood of recommendation for DRF surgery, even after controlling for fracture severity and individual-level confounding variables. This suggests variability in DRF management based on individual patient factors. Type of study/level of evidence: Prognostic III.

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