The Impact of Social Deprivation on Phalangeal Fracture Operative Treatment Outcomes

Abstract

Purpose: The purpose of this study was to evaluate the relationship between social determinants of health and outcomes following phalangeal fracture surgery using the Area Deprivation Index.

Methods: A retrospective chart review was performed on patients ≥18 years old who underwent surgical fixation of a proximal, middle, or distal phalangeal fracture at our level I trauma center from January 2006 to December 2018. Surgical techniques included open reduction and internal fixation, closed reduction and percutaneous pinning, intramedullary fixation, and external fixation. Patients with multiple fractures or who required nonsurgical treatment were excluded. Demographics, comorbidities, range of motion, visual analog scale pain scores, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were analyzed. The Area Deprivation Index categorized patients into terciles by their relative deprivation level. Statistical tests included analysis of variance, chi-square tests, and multivariate logistic regression.

Results: In total, 194 patients were included. The most deprived group had a greater proportion of Black/African Americans. No significant differences were observed in fracture patterns, surgical technique, or implant utilization. Preoperative pain scores were greater in the most deprived group (6.05 ± 2.61) compared with the least deprived group (3.95 ± 2.80). Postoperative pain was also higher in the most deprived group (2.14 ± 2.46) versus the least deprived group (0.50 ± 0.73). Preoperative QuickDASH scores were greater in the most deprived group (61.36 ± 22.94) compared with the intermediately deprived group (46.04 ± 20.59).

Conclusions: Social deprivation may influence preoperative and postoperative pain in phalangeal fracture surgery. Considering socioeconomic factors could help address underlying disparities and enhance patient recovery.

Type of study/level of evidence: Prognostic III.

Keywords: Fracture; Hand; Phalangeal; Phalanx; Social.

Figure 1

Surgical treatment distribution: a graphical representation of the distribution of surgical treatment techniques used during phalangeal fracture repair surgery, including closed reduction and percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), and external fixation.

Figure 2

Surgical technique and implant combination distribution: a depiction of the distribution of various surgical techniques and implant combinations used operatively, including closed reduction and percutaneous pinning (CRPP) with Kirschner wires (K-wires), open reduction and internal fixation (ORIF) with lag screws, ORIF with plates and screws, intramedullary fixation (IMF) with headless compression screws, and external fixation using an external fixator.