ArticleJournal of the Pediatric Orthopaedic Society of North America2026
Socioeconomic Disparities in Secondary Procedures for Pediatric Distal Radius Fractures.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Repeat reduction and surgical fixation are often performed in children with distal radius fractures failing initial closed reduction (CR). While socioeconomic disparities have been described in adult orthopaedic conditions, less is known about the pediatric population. The purpose of this investigation was to determine risk factors, if any, for differences in secondary procedure rates in children with distal radius fractures. Methods: Of 2,072 patients in a multicenter prospective cohort of pediatric distal radius fractures, 270 had radiographic loss of reduction (LOR) following initial CR and casting. Rates of secondary intervention (eg repeat reduction, surgery) were compared by race, insurance status, Childhood Opportunity Index (COI, lower score denotes greater opportunity), Area Deprivation Index (lower score denotes less deprivation), and geographic distance to the treating center. Mixed-effect general linear modeling was used to assess associations between racial and socioeconomic characteristics on the likelihood of secondary intervention clustered by site. Odds ratios (ORs) along with 95% confidence intervals (CIs) are reported. Results: Thirty-five patients (13%) underwent secondary procedures at a median 12 days following the initial CR. Patients requiring secondary intervention demonstrated greater fracture angulation (21° vs 16°, Conclusions: In this multicenter cohort, secondary procedures after LOR were more likely to be performed in White patients, privately insured patients, and patients with lower social deprivation. After adjustment for fracture characteristics, greater childhood opportunity and fracture deformity remained independently associated with secondary intervention. Key Concepts: (1)Variations in secondary intervention rates for pediatric distal radius fractures are not well understood.(2)Patients with a better Childhood Opportunity Index, who have private insurance, and who identify as White are more likely to receive secondary interventions for loss of reduction of pediatric distal radius fractures.(3)Further investigation is needed to delineate the root cause of these observed disparities. Level of Evidence: II.
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