Barriers and Facilitators to Timely Distal Radius Fracture Care

Abstract

Introduction

Despite mounting evidence that delays in the surgical treatment of displaced distal radius fractures can adversely affect outcomes, factors such as insurance type and language have been associated with disparities in time to surgery (TTS) in quantitative studies. We sought to better characterize the specific barriers and facilitators to timely surgical care of operative distal radius fractures using qualitative methods.

Methods

In this multi-institutional study, we recruited English, Spanish, Mandarin, and Cantonese-speaking patients aged ≥18 years old with isolated, closed distal radius fractures treated with surgical fixation. Patients were invited to participate if their surgery was delayed (defined as ≥10 days between injury and surgery). Malunions (surgery >6 weeks after injury) were excluded. Interviews were conducted using a semi-structured interview guide and were audio recorded, de-identified, and transcribed verbatim. Thematic analysis was conducted using a deductive approach guided by the Models of Pathways to Treatment framework, which describes the events, processes, and intervals from the initial injury to the start of treatment. Representative quotes were selected to illustrate key barriers and facilitators following the four intervals defined by the framework: appraisal, help-seeking, diagnostic, and pre-treatment.

Results

Eighteen individuals (mean age 55.2 ±17.4 years) completed a semi-structured interview; 83% were female. The average TTS (SD) was 14.2 days (3.4), with a range of 10-22 days. Barriers (N=113) such as the minimization of symptoms (appraisal), language challenges (help-seeking), healthcare system inefficiency (diagnostic), and lack of insurance coverage (pre-treatment) were identified as key factors to delays in diagnosis and treatment. Facilitators (N=117) such as the presence of social support (appraisal), patients’ familiarity with the hospital system (help-seeking), early involvement of orthopaedic surgeons rather than other non-specialized providers (diagnostic), and thorough patient education (pre-treatment), were recognized as factors that may help minimize delays.

Conclusion

Qualitative interviews identified factors influencing timely surgical care for distal radius fractures. Distal radius fractures involve multiple care phases, each with compounding roadblocks. Findings highlight the need for targeted interventions such as streamlined referral pathways, expanded multilingual patient education, and policy changes addressing insurance-related delays.