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
