AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Final Program
2016 Annual Meeting Photos
Past & Future Meetings


Back to 2016 Annual Meeting Program


Is Insurance Status Associated with Development of Nonunion Following Scaphoid Fracture?
Amy K. Fenoglio, MD1; Daniel D. Bohl, MD, MPH2; Raj J. Gala, MD1; Seth D. Dodds, MD1
1Yale School of Medicine, New Haven, CT; 2Rush University Medical Center, Chicago, IL

Introduction: Scaphoid nonunion is a common precursor to radiocarpal arthrosis. A number of factors have been associated with development of scaphoid nonunion, including delayed diagnosis, inadequate initial management, proximal location, and carpal instability. We hypothesized that insurance status would also be a risk factor for development of scaphoid nonunion.

Materials & Methods: A case-control study was performed on patients who presented to a single surgeon at a tertiary referral center during 2006-2015. Cases were defined as patients presenting with nonunions. Controls were defined as patients presenting with primary fractures. Insurance status was characterized as underinsured if the patient lacked any type of insurance or if the patient was on Medicaid. Case/control status was tested for association with patient and fracture characteristics, including age, sex, fracture displacement, fracture location, laterality of fracture, and insurance status.

Results: A total of 71 patients were identified. Of these, 39 (55%) were nonunions (cases) and 32 (45%) were primary fractures (controls). Cases were more likely than controls to have had displaced fractures (72% versus 41%, p=0.008; Table 1). Cases were also more likely than controls to have fractures located at the proximal aspect (18% versus 0%) and less likely than controls to have fractures located at the distal aspect (0% versus 19%; p<0.001). Finally, cases were more likely than controls to be underinsured (46% versus 19%, odds ratio = 3.7, 95% confidence interval = 1.3-11.0, p=0.015, Figure 1).

Conclusion: Patients presenting with nonunions were more likely than patients presenting with primary fractures to be underinsured. This finding suggests that underinsurance is a risk factor for development of nonunion. Given that delay between fracture and intervention is a known risk factor for development of nonunion, it is likely that the association between nonunion and underinsurance is mediated through this delay. Increased attention should be turned to timely and standard of care management of primary fractures in those who lack adequate insurance.


Back to 2016 Annual Meeting Program
© 2017 American Association for Hand Surgery. Privacy Policy.