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

BACKGROUND: There is a higher incidence of scaphoid fractures in children with lower socioeconomic status (SES), who may be more likely to underutilize health care resources. This study investigated the association between socioeconomic factors and the clinical course of nonoperatively 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 and 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 (interquartile range [IQR], 2.0-7.3), and that 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 < .001; state, P < .001), ADI (national, P < .001; state, P = .002), and SVI (P < .001). Children in the lowest COI national quintile presented to an orthopaedic specialist 4.5 days later (P = .024) and underwent immobilization 7.4 days longer (P < .001) than other patients. Publicly insured patients were immobilized 7.4 days longer than children with private insurance (P < .001). Children living with both biological parents were immobilized 4.4 days fewer than those in other household configurations (P < .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 health care access and to understand the consequences of treatment delays.

KEY CONCEPTS: (1)Lower socioeconomic status (SES) is associated with delayed orthopaedic specialist presentation and prolonged rigid immobilization in children with acute, nonoperatively treated scaphoid fractures.(2)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.(3)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.(4)SES was not associated with increased risk of nonunion or failed nonoperative treatment and progression to surgery.(5)Further research is needed to fully elucidate the relationship between SES and health care access in pediatric scaphoid fractures and to understand the consequences of delayed or prolonged treatment in this population.

LEVEL OF EVIDENCE: III, Retrospective Cohort Study.