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Socioeconomic Disparities in Secondary Procedures for Pediatric Distal Radius Fractures
Journal article   Open access   Peer reviewed

Socioeconomic Disparities in Secondary Procedures for Pediatric Distal Radius Fractures

Rebecca D. Aguiar, Apurva S. Shah, Mark Miller, Michael Willey, Susan Mahan, Ata Kiapour, Patricia E. Miller and Donald S. Bae
Journal of the Pediatric Orthopaedic Society of North America, 100439
08/2026
DOI: 10.1016/j.jposna.2026.100439
url
https://doi.org/10.1016/j.jposna.2026.100439View
Published (Version of record) Open Access

Abstract

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. 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 (e.g. repeat reduction, surgery) were compared by race, insurance status, childhood opportunity index (COI, lower score denotes greater opportunity), area deprivation index (ADI, lower score denotes less deprivation), and geographic distance to the treating center. Mixed-effects general linear modeling assessed associations between racial and socioeconomic characteristics on the likelihood of secondary intervention clustered by site. Odds ratios (OR) along with 95% confidence intervals (CI) are reported. Thirty-five patients (13%) underwent secondary procedures at a median 12 days following initial CR. Patients requiring secondary intervention demonstrated greater fracture angulation (21° vs. 16°, p=0.002) and translation (p=0.01) at initial LOR and experienced LOR earlier after CR (median 10 vs. 14 days, p=0.02). Furthermore, White patients (17% (30/179) vs. 5% (4/84) non-White patients), p=0.03), patients transferred from outside hospitals (p=0.01), patients with private insurance (p=0.02), and patients with lower COI (greater opportunity; p=0.006) were more likely to undergo secondary procedures. In the final multivariable model, each one-unit increase in COI (reflecting lower childhood opportunity) was associated with a 41% reduction in the odds of secondary intervention (OR 0.59, 95% CI 0.41-0.81; p=0.003), after adjustment for age and fracture angulation and translation at the time of LOR. 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. II 1.Variations in secondary intervention rates for pediatric distal radius fractures are not well understood.2.Patients with better childhood opportunity index, who have private insurance, and 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.
 Childhood opportunity Distal Radius Fractures Social deprivation

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