Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 1;45(2):64-67.
doi: 10.1097/BPO.0000000000002864. Epub 2024 Nov 18.

Pediatric Scaphoid Nonunions: Does Insurance Status Play a Role?

James S Lin  1 , James MacDonald  2 , Julie Balch Samora  3
Affiliations

Pediatric Scaphoid Nonunions: Does Insurance Status Play a Role?

James S Lin et al. J Pediatr Orthop. .

Abstract

Objective: There are no studies that evaluate the effects that insurance or socioeconomic status may have on treatment and outcomes of scaphoid nonunions in children. We evaluated whether there is an association between insurance status and (1) time from injury to hand surgeon evaluation, (2) time from specialist evaluation to surgery, and (3) postoperative outcomes of scaphoid fracture nonunions in children.

Methods: A chart review was performed for patients who underwent surgical treatment of scaphoid fracture nonunion from January 2015 and April 2021 at a large tertiary care pediatric hospital. Underinsured patients were defined as those with no medical insurance or Medicaid/state-funded insurance.

Results: There were 21 privately insured patients and 17 patients who were underinsured. There was no difference in age, race, or fracture characteristics between the two groups. The mean time between injury and hand surgeon evaluation was 192 SD 195 days for the privately insured group compared with 155 SD 205 days for the underinsured group (P = 0.57). The mean time between specialist evaluation and surgical treatment was 35 SD 54 days for the privately insured group and 31 SD 31 days for the underinsured group (P = 0.82). Union was achieved in 80% of patients with private insurance compared with 88% of underinsured patients after primary surgery (P = 0.67). There was no difference detected in the proportion of patients who had residual pain (15% vs 19%), range of motion deficits (38% vs 40%), strength deficit (6% vs 7%), and return to activity (94% vs 93%) between privately insured and underinsured patients, respectively (P = 1.00).

Conclusions: There was no difference in time from injury to specialist evaluation, time from evaluation to surgery, or postoperative outcomes based on insurance status for pediatric patients with scaphoid fracture nonunions. Although insurance status was not associated with access to care for pediatric scaphoid fracture nonunions at our institution, this information may not be generalizable to other populations, including patients who sustain primary scaphoid fractures and who have not yet developed nonunions.

Level of evidence: Level III-retrospective cohort study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Almaguer AM, Hsu AR, Pearson JM, et al. Do geographic region, Medicaid status, and academic affiliation affect access to care among Medicaid and privately insured total hip arthroplasty patients? J Arthroplasty. 2019;34:2866–2871.
    1. Smith HE, Mistovich RJ, Cruz AI, et al. Does insurance status affect treatment of children with tibial spine fractures? Am J Sports Med. 2021;49:3842–3849.
    1. Bram JT, Talathi NS, Patel NM, et al. How do race and insurance status affect the care of pediatric anterior cruciate ligament injuries? Clin J Sport Med. 2020;30:e201–e206.
    1. Skaggs DL, Lehmann CL, Rice C, et al. Access to orthopaedic care for children with Medicaid versus private insurance: results of a national survey. J Pediatr Orthop. 2006;26:400–404.
    1. Iobst C, Arango D, Segal D, et al. National access to care for children with fractures. J Pediatr Orthop. 2013;33:587–591.

LinkOut - more resources