Follow-up After Proximal Femur Fracture Fixation-We Need to Do Better.

Area of Science:

• Pediatric Orthopedics
• Health Services Research

Background:

• Long-term follow-up is crucial after proximal femur fractures to detect complications like avascular necrosis (AVN).
• Sociodemographic factors may influence patient adherence to follow-up schedules.

Purpose of the Study:

• To identify sociodemographic characteristics associated with lost-to-follow-up (LTFU) status in pediatric patients with proximal femur fractures.
• To evaluate the impact of insurance status and area deprivation index (ADI) on follow-up adherence.

Main Methods:

• Retrospective case series of pediatric patients (<18 years) treated for proximal femur fractures.
• Data collected from electronic medical records (EMR); ADI determined by patient addresses.
• LTFU defined as <2 years follow-up without surgical discharge; AVN assessed via imaging.

Main Results:

• Of 42 patients, 42.9% were LTFU. The LTFU group had higher proportions of Medicaid/uninsured patients and greater state/national ADI.
• Commercial insurance was linked to significantly longer follow-up (940.6 days) versus Medicaid (295.9 days) or uninsured (347.7 days).
• Multivariate analysis confirmed ADI as a significant factor for LTFU, even after adjusting for distance to clinic.

Conclusions:

• Significant disparities exist in follow-up care for pediatric proximal femur fractures.
• Insurance status and ADI are key predictors of LTFU, necessitating targeted quality improvement initiatives.
• Further research is needed to understand the impact of social determinants of health on follow-up compliance.