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

Emma T Smolev1, Rafa Rahman1, Amy Z Lu1

  • 1Department of Hand and Upper Extremity, Hospital for Special Surgery, New York, NY.

Journal of Hand Surgery Global Online
|December 9, 2025
PubMed
Summary

Patient insurance status, not geographic disadvantage, influences surgical recommendations for distal radius fractures. Public insurance was linked to fewer operative recommendations, indicating potential care disparities in orthopedic treatment.

Keywords:
DisparitiesDistal radius fractureGeographic socioeconomic disadvantagePublic health insuranceTreatment recommendation

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Area of Science:

  • Orthopedic surgery
  • Health services research
  • Health equity

Background:

  • Distal radius fractures (DRFs) are common orthopedic injuries with variable surgical indications.
  • Existing disparities in patient care highlight the need to investigate factors influencing treatment decisions.
  • Understanding socioeconomic influences on DRF management is crucial for equitable care.

Purpose of the Study:

  • To determine if insurance status is associated with surgical treatment recommendations for dorsally angulated DRFs.
  • To assess if geographic socioeconomic disadvantage (Area Deprivation Index) impacts surgeon treatment recommendations for DRFs.
  • To identify potential disparities in orthopedic care for distal radius fractures.

Main Methods:

  • Retrospective cohort study of 891 patients with DRFs from 2016-2021.
  • Multivariable logistic regression analyzed associations between insurance status, Area Deprivation Index, and operative recommendation.
  • Adjusted for fracture severity (mild, moderate, severe), radial inclination, ulnar variance, ulnar styloid fracture, sex, age, and Elixhauser Comorbidity score.

Main Results:

  • Public health insurance was significantly associated with a lower likelihood of surgical recommendation for DRFs.
  • No significant association was found between geographic socioeconomic disadvantage (Area Deprivation Index) and treatment recommendation.
  • Overall, 77% of patients were recommended surgery, and 74% underwent operative management.

Conclusions:

  • Insurance status, specifically public insurance, is a significant factor influencing surgical recommendations for distal radius fractures.
  • Variability in DRF management based on patient insurance status suggests potential inequities in orthopedic care.
  • Further research is needed to address disparities in orthopedic fracture management.