The Association Between Socioeconomic Factors and the Clinical Course of Nonoperatively Treated Pediatric Scaphoid Fractures

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Background There is a higher incidence of scaphoid fractures in children with lower socioeconomic status (SES), who may be more likely to underutilize healthcare resources. This study investigated the association between socioeconomic factors and the clinical course of non-operatively treated pediatric scaphoid fractures. We hypothesized that lower SES would be associated with delayed and prolonged treatment. Methods This retrospective study included patients <21 years old who presented to a single institution with an acute scaphoid fracture between 2012-2024. Demographic and clinical information were obtained from the electronic health record. SES factors included insurance status, household composition, Child Opportunity Index (COI), Area Deprivation Index (ADI), and Social Vulnerability Index (SVI). Descriptive statistics, nonparametric tests, and regression analyses examined the relationship between SES and clinical course. Results The study included 736 patients (mean age 13.6±2.5 years; 69% male). The median time from injury to rigid immobilization was 4.0 days (IQR, 2.0-7.3), and to orthopaedic specialist presentation was 5.0 days (IQR, 2.0-9.0). The median duration of immobilization was 38.0 days (IQR, 28.0-43.0), with longer immobilization observed in patients with lower SES per COI (national, p<0.001; state, p<0.001), ADI (national, p<0.001; state, p=0.002), and SVI (p<0.001). Children in the lowest COI national quintile presented to an orthopaedic specialist 4.5 days later (p=0.024) and underwent immobilization 7.4 days longer (p<0.001) than other patients. Publicly insured patients were immobilized 7.4 days longer than children with private insurance (p<0.001). Children living with both biological parents were immobilized 4.4 days fewer than those in other household configurations (p<0.001). SES factors were not associated with scaphoid nonunion or progression to surgery. Conclusions In pediatric scaphoid fractures, lower SES is associated with delayed orthopaedic specialist presentation and prolonged rigid immobilization, although not nonunion or progression to surgery. Treatment delays may be due to barriers that limit access to orthopaedic specialists or prevent timely follow-up. Further research is needed in this population to elucidate the relationship between SES and healthcare access and to understand the consequences of treatment delays. Levels of Evidence III, retrospective cohort study Key Concepts • Lower socioeconomic status is associated with delayed orthopaedic specialist presentation and prolonged rigid immobilization in children with acute, non-operatively treated scaphoid fractures. • Delays in care may be due to barriers that limit access to orthopaedic specialists after injury and prevent timely follow-up after initiation of rigid immobilization. • These disparities are concerning, as delays in rigid immobilization and prolonged rigid immobilization may negatively impact clinical outcomes, school performance, sports participation, and social engagement. • Socioeconomic status was not associated with increased risk of nonunion or failed nonoperative treatment and progression to surgery. • Further research is needed to fully elucidate the relationship between SES and healthcare access in pediatric scaphoid fractures and to understand the consequences of delayed or prolonged treatment in this population.

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