Is there an association between socioeconomic factors and hardware failure after ankle fracture fixation? A...

Hardware failure following ankle fracture fixation is an established complication traditionally attributed to fracture pattern, fixation construct, bone quality, and postoperative weight-bearing status. The relationship between community-level social vulnerability and hardware failure requiring removal after ankle open reduction internal fixation (ORIF) remains poorly defined.

To evaluate whether patients residing in socioeconomically vulnerable areas experience higher rates of hardware failure following ankle fracture fixation.

Retrospective cohort study METHODS: Patients who underwent unplanned hardware removal after ankle fracture fixation were identified using Current Procedural Terminology (CPT) code 20680. The control group consisted of patients who underwent operative ankle fracture fixation during the study period without subsequent hardware removal. Demographic data and residential zip codes were extracted from the electronic medical record, and zip codes were mapped to counties to assign county-level Social Vulnerability Index (SVI) scores.

Patients residing in Lucas County, Ohio, demonstrated greater social vulnerability than those in surrounding counties, particularly within the socioeconomic status and racial and ethnic minority status themes. Age demonstrated a small statistically significant association with hardware removal (OR, 1.014; 95% CI, 1.002, 1.027; P = 0.022), although age was not the primary focus of this analysis.

Socioeconomic and environmental factors remain clinically relevant to postoperative care after ankle fracture fixation. The concentration of patients from a higher-socially vulnerable region highlights the need to better characterize how social vulnerability, care access, follow-up adherence, and community-level barriers may affect hardware-related outcomes.