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J Wrist Surg 2018; 07(04): 288-291
DOI: 10.1055/s-0038-1639509
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Impact of Insurance Status on the Development of Nonunion following Scaphoid Fracture

Seth D. Dodds
1   Department of Orthopaedic Surgery and Rehabilitation, University of Miami, Miller School of Medicine, Miami, Florida
,
Amy K. Fenoglio
2   Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
,
Daniel D. Bohl
3   Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Raj J. Gala
2   Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations Funding None.
Further Information

Publication History

25 August 2017

21 February 2018

Publication Date:
04 April 2018 (online)

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Abstract

Purpose Certain factors have been associated with the development of scaphoid nonunion, including delayed diagnosis, smoking, inadequate initial management, proximal location, and carpal instability. We hypothesized that insurance status would also be a risk factor for the development of scaphoid nonunion.

Methods A case–control study was performed on patients who presented to a single surgeon at a tertiary referral center during 2006 to 2015. Cases were patients presenting with nonunions, controls, and patients with acute fractures. Patients were characterized as underinsured if they lacked any type of insurance or if they were on Medicaid.

Results Patients (39 nonunions [cases] and 32 primary fractures [controls]) presenting with nonunions were more likely than controls to have had displaced fractures (72 vs. 41%) and fractures located at the proximal aspect of the scaphoid (18 vs. 0%), and to be underinsured (46 vs. 19%).

Conclusion Patients presenting with nonunions were more likely to be underinsured than patients presenting with primary fractures. This finding suggests that underinsurance is a risk factor for the development of nonunion. Assuming delay between fracture and intervention is a known risk factor for the development of nonunion, and it is likely that the association between nonunion and underinsurance is mediated through this delay.

Level of Evidence Prognostic, level III, case-control study.

Keywords

scaphoid fracture - insurance - scaphoid nonunion

Note

This work was performed at the Yale School of Medicine, New Haven, Connecticut.


 

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