The Effect of Psychosocial Factors on Nonoperatively and Operatively Treated Adult Distal Radius Fractures.

Abstract

Background: Psychosocial factors may play a role in the management of distal radius fractures (DRF). The purpose of this study was to explore how psychiatric history and socioeconomic status affect access to care, patient-reported outcomes (PROs) and complications after adult DRF. Methods: A retrospective cohort study of adult patients from 2005 to 2015 with a DRF was conducted. PROs were collected via DASH and VAS questionnaires. Socioeconomic status was inferred through insurance status and Area Deprivation Index (ADI) based upon the patient's ZIP code of residence. Complications and reoperations were collected. Statistical analysis consisted of generalised estimating equations (GEE) with a logistic link to account for repeated measures of individual subjects. Results: A total of 316 patients were studied. Psychiatric history was associated with increased time from injury to first clinic visit with a hand surgeon by a mean of 3.3 days, while time to surgery was increased with higher ADI percentile by a mean of 0.08 days per ADI percentile. Psychiatric history and higher ADI percentiles were associated with higher DASH scores by a mean of 8.9 points and 0.22 points per ADI percentile, respectively. VAS scores and complication or reoperation rates were not statistically affected by psychiatric history, insurance or ADI. Conclusions: Patients with a psychiatric history or those residing in a more socioeconomically disadvantaged neighbourhood have increased time to follow-up and surgery as well as worse DASH scores following DRF. Level of Evidence: Level III (Diagnostic).