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Lower Socioeconomic Status Is Associated with Prolonged Casting in Children with Scaphoid Fractures
Stone R. Streeter, BS, Simon Blanchard, BS, Dev Laungani, BA, Casey C. Kuka, BS, Sayaka Mori, BA, Scott J. Mahon, BS, Sulagna Sarkar, MS; Apurva S. Shah, MD, MBA
Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Scaphoid fractures are the most common carpal injury in children. Treatment delays increase the risk of nonunion and can lead to progressive arthritis. Scaphoid fractures have a higher incidence in patients with lower socioeconomic status (SES), which is frequently associated with delayed utilization of healthcare services. However, this concept has not been thoroughly investigated in pediatric fractures. The purpose of this study was to explore the relationship between SES and the clinical course of scaphoid fractures in the pediatric population. We hypothesized that lower SES would be associated with delayed casting.
Materials and Methods: This retrospective study included consecutive patients <21 years old who presented to a single institution with an acute scaphoid fracture between 2012-2024. Patients were excluded if they were immediately recommended for surgery, were lost to follow-up, or did not have sufficient SES data. Demographic and clinical data were obtained from the electronic health record. SES was quantified using the Child Opportunity Index (COI), Area Deprivation Index (ADI), and Social Vulnerability Index (SVI). The relationship between clinical characteristics and SES was elucidated using linear regressions (p<0.05).
Results: The final data set consisted of 457 patients with a median age of 12.9 years old. The median time from injury to both specialist presentation and casting was 4.0 days, and the median duration of casting was 35.0 days. Patients were pain free and cleared to return to sports at a median of 41.0 and 58.0 days, respectively. There was no significant relationship between SES and time to specialist presentation or casting. However, duration of casting was significantly associated with SES. Patients who underwent prolonged casting had higher SVI scores (p=0.004) and lower COI national (p=0.005) and state scores (p=0.009), indicating lower SES. Furthermore, children falling in the lowest COI national quintile were casted for an average of 4.2 days longer than those who were in the highest quintile.
Conclusion: In this study, lower SES was associated with prolonged casting in children with scaphoid fractures. This may be due to barriers of care that contribute to delays in cast removal. Prolonged casting can have a negative impact on school performance, sports participation, and social coherence. Thus, additional research is needed to further elucidate the relationship between SES and healthcare equity in this population.
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