Scientific Abstract Presentations: Hand 4 Saturday, October 28 Sat, Oct 28 2:00-3:30 p.m. CDT

Introduction: Heterotopic ossification (HO) is an uncommon but debilitating sequela of burn injury with an incidence of approximately 5%. Although HO is a feared and debilitating problem in burn recovery, little is known about long-term outcomes of people living with HO. The purpose of this study was to identify demographic characteristics of individuals who develop HO as well as compare patient reported outcomes in the following domains: anxiety, depression, social integration, pain, fatigue, sleep, and physical function to the general burn population.

Methods: Using the Burn Model System National Longitudinal Database, participant demographics, injury characteristics, and PROMIS-29 scores were collected from 2015-2022. Participants with HO were included. We analyzed PROMIS-29 outcomes including domains of anxiety, depression, fatigue, sleep, pain, physical function, and social integration across three time points (discharge, six- and 12- months post injury). Mixed-effects linear regression models were used to compare PROMIS scores across all three longitudinal measurements. Models were adjusted for age, sex, race/ethnicity, HO status, and burn size.

Results: Of the 630 participants with data concerning HO, 20 were diagnosed with HO (3% of participants). Most patients with HO were male (n = 15, 75%) and had an average age of 41 +/-14 years. Fourteen participants (70%) were Non-Hispanic White and 6 participants (30%) were Hispanic/Latino. Participants with HO had significantly larger burn size (48 +/-24% TBSA) than those without HO (16 +/-16%, p<0.001). After adjusting for covariables, patients with HO reported significantly lower physical function than patients without HO. There were no differences in anxiety, depression, fatigue, sleep interference, pain interference, and social integration between patients with and without HO. Regardless of HO status, older age was associated with worse physical function (β= -0.18, p<0.001), pain interference (β=0.07, p<0.001), and social integration (β= -0.07, p=0.001) at all time points across the study period. Larger burn size and female sex were associated with worse outcomes across all seven domains at all study time-periods.

Conclusions: Physical functioning was consistently lower in patients with HO compared to those without. However, psychosocial outcome measures were not significantly different amongst the two populations. While HO can result in physical limitations, the translation to psychosocial impairments were not evident. A focus on maximizing physical function for populations at risk for HO should be the focus in recovery.

Soft tissue defects of the volar digits can be challenging to reconstruct. Toe pulp flaps and medialis pedis flaps are two commonly used flaps for volar digital soft tissue reconstruction, each with its advantages and disadvantages. Toe pulp flaps offer similar anatomical features to the pulp of fingers and thumbs, and digital nerves can be coapted for flap innervation. (1,2) However, toe pulp flaps require more donor site management, which may result in complications such as numbness, pain, and hypersensitivity. Medialis pedis flaps, on the other hand, provide glabrous skin for reconstruction, which minimizes donor site morbidity. (2) Nevertheless, medialis pedis flaps are not innervated and may not provide adequate sensory recovery. The purpose of this study was to compare the functional outcomes, sensibility, and subjective complaints of patients who received either toe pulp flaps or medialis pedis flaps for volar digital soft tissue reconstruction. This study aimed to provide evidence-based guidance on selecting the most suitable flap for volar digital soft tissue reconstruction.

A total of 101 patients who underwent toe pulp flap or medialis pedis flap reconstruction for volar digital defects between 1998 and 2017 were included in this study. Patient-reported outcomes were evaluated by three questionnaires, including the Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Development of the Foot and Ankle Disability Index Questionnaire (FADI). Sensory recovery was evaluated by static two-point discrimination test (s2PD), moving two-point discrimination test (m2PD), and Semmes-Weinstein monofilament (SWM) test. Donor and recipient site subjective complaints were also collected, and the donor site scars were evaluated by the Vancouver Scar Scale.

The results showed that both the toe pulp flap and medialis pedis flap reconstruction provided satisfactory patient-reported functional outcomes and comparable sensory recovery. No significant difference was observed in the sensory recovery between the two groups, although toe pulp flaps were innervated with digital nerves. However, donor site discomfort was more common in the toe pulp flap group, which was mainly due to the use of skin grafts for donor site closure. The medialis pedis flap can be preferred for defects with a width greater than 1.5 cm to avoid skin graft reconstruction to the donor site.

In conclusion, the toe pulp flap and medialis pedis flap are both feasible for volar digital soft tissue reconstruction. The choice of the flap should be based on the defect size and the preference of the surgeon.

References: 1. Lin, C. H., Lin, Y. T., Sassu, P., Lin, C. H., Wei, F. C. Functional assessment of the reconstructed fingertips after free toe pulp transfer. Plastic and Reconstructive Surgery 2007;120:1315-1321. 2. Koshima, I., Inagawa, K., Urushibara, K., Okumoto, K., Moriguchi, T. Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 2000;105:1666-1674. 3. Tsai, F. C., Cheng, M. H., Chen, H. C., Wei, F. C. Microsurgical medialis pedis flaps for reconstruction of soft-tissue defects in the hand. Ann Plast Surg 2002;48:41-47.

Aim: Mallet finger deformity is one of the most frequent pathological entities after extensor tendons injuries, which appears as result of the disruption of extensor tendon continuity over the distal interphalangeal joint. Despite the fact that a lot of methods were used in managing this deformity, the treatment of mallet finger is still a much debated subject. Material and method: We present a new surgical method by using a dorsal deepithelia-lised flap reinserted through the bone. The procedure consists in performing an intra-dermal incision that delimitates a flap on the dorsal aspect of the second phalanx, the distal end of the flap coinciding to the DIP joint; the width of the flap is of 3-5 mm. The flap is de-epithelialized and raised superficial to the tendon. At the level of extensor insertion a hole of 1-1.5 mm is done. A 4/0 steel thread is passed through the distal end of the flap and is then passed through the intra-osseous hole and knotted palmary in a tie-over manner. The extensor tendon is sutured with 4/0 absorbable threads to the flap. The skin is closed over the flap. Postoperatively we immobilise only the DIP joint. The Kirschner wire is removed after three weeks, the steel thread after four weeks and the immobilization after five weeks. We used this method in 97 cases. Results: The patients regain 95-100% of DIP stability and mobility, with an extension deficit of 0 to 10 degrees. Conclusion: This simple and effective method avoids a prolonged and uncertain immobilization and has a significantly high rate of success. The method uses local resources and avoids the rejection phenomenon related to allograft materials. The distal trans-osseous reinsertion and centro-medular wiring are important technical adjuvant and improve the final results.

Introduction Direct traumatic open fractures or their complications, as osteomyelitis and nonunion, represent the main etiology of bone defects. If soft tissue defects are also present, the management of these lesions becomes more challenging. The most used flaps in these cases are the vascularized fibula osteoseptocutaneous flap, the vascularized iliac osteocutaneous flap, and the vascularized muscular-rib flap. We previously reported about the advantages and the few complications by using the muscle-rib flap, and about the advantages of all-in-one reconstruction in complex injuries of the limbs involving both bone and soft tisuue defects by using these flaps. Materials and Methods The study refers to 32 patients operated for acute or sequelar traumatic composite bone and soft tissue defects in upper limb, between March 1997 and March 2023, 8 females and 24 males, with an average age of 30,5 years (range, 5 to 66 years). The etiology of the defects was an acute trauma in 17 cases, and a posttraumatic complication in 15 cases. The average length of the bone defect was 5,2 cm (range, 3 to 8 cm), and the surface of soft tissue defect ranged between 6 and 475 cm2. The flap used was the SA-R in 14 cases, the LD-R in 11 cases, and the LD-SA-R in the remaining 7 cases; from these, 23 were free flaps, and 9 pedicled flaps. Results The average follow-up in our 32 patients was 23,1 months (range, 12 to 48 months). We had complete flap survival in all the cases. In only one case we registered a superficial wound infection, which was solved conservatively. Regarding the long term results, we registered a rate of primary bone union of 100%, with an average time of 6,6 months. Conclusions The vascularized rib(s) as part of a composite flap represents a good indication especially in bone defects associated with large soft tissue defects

Introduction: Several variations of local skin flaps have been described for syndactyly web space reconstruction, including the dorsal rectangular flap, dorsal triangular flap, or the interdigitating V-flap. The dorsal pentagonal advancement flap incorporate more dorsal skin and promotes a better web design, and as a unique flap decreases the surgical time. There is a need to evaluate objectively the final result with a concrete parameter. We studied the distance between the neo-web and the distal palmar crease. Patients and Methods: From January 2017 to July 2022, 20 patients, 3 to 5 years old, were included in this study with unilateral congenital hand syndactyly, at the third web space, presenting complete or incomplete fusion. They were treated with dorsal pentagonal flap for web space reconstruction and rectangular interdigitating flaps for finger border coverage. Two proximal areas needed skin grafting; the contralateral retroauricular full-thickness skin was used. The long axis of the pentagonal flap was calculated based on the distance from the a normal contralateral metacarpo-falangeal eminence to the web. The distance between the medial point of neo-interdigital border and the distal palmar crease was measured at the and of the procedure and 180 days post-surgery. The same measurements were done in the normal hand. The results were classified in 3 levels: 1. "Good" – normal depth, perfect skin coverage and no retractions. "Satisfactory"- small level of web anteriorization, discrete skin retractions without functional impairment. 3. "Poor"- need for surgical revision. Results: The results were considered "Good" in 17 patients and in in 3 considered "Satisfactory". No one needed surgical revision. The measured distance between the neo-web and the distal crest increased in all cases, in the 17 good results the increase was less than 10%, in the 3 patients were considered "Satisfactory" the increase was between 13 and 15% of the initial measure. Conclusion: The advantage of using the pentagonal flap is to reconstruct the dorsal depression and to have the web aligned with the ventral surface with an anatomical normal aspect. A unique flap instead of two triangular guaranties a better result even the skin grafts doesn't integrate completely. The use of the distance between the web and the distal palmar crease is a good reference to compare and classify results.

Purpose: The functionality of hands determines the quality of life in burn survivors. Deep dermal in concomitant with full-thickness burn that involves dorsum and volar hands results in narrowing web space, clawing of the fingers, and burn syndactyly leading to functional impairment of hands. Unique anatomical characteristics of hand including pliable soft tissue over dorsal hand and glabrous skin of the palm make optimal functional restoration for burn hand contracture challenging for plastic surgeon. Our purpose is to share our experience in one-stage hand reconstruction and to present the optimal outcome of full-fist position and acceptable donor site aesthetics. Materials and Methods: Regardless of the medical history, patients who underwent extensive hypertrophic scar excision at fingers and dorsum of hand combined with full thickness skin graft resurfacing in a single surgery for post scar contracture correction in hand in our institute from March 2016 to October 2017 were recruited. Patient profile, injured mechanism, and range-of-motion of finger joints were recorded. Results: 36 patients (17 males, 18 females) with 70 hands were included in the study. All hands have shown scar contracture over fingers, web space or dorsum of hand. The pre-operative supination-pronation test and range of motion over metacarpal phalangeal joint, phalangeal joint and wrist joint were measured with goniometer and physical examination. Limitations ranged from -10 degree to 70 degree were recorded. In addition to scar excision and full thickness skin graft resurfacing, 10 hands underwent simultaneous tendon lengthening. All donor sites were primary closed with optimal aesthetic outcome achieved. Only one patient presented minimal hematoma as a minor complication, which resolute itself spontaneously after weeks. After surgical correction, 90% of the hands can reach full-fist position and full fingers abduction. Patients regained some simple hand functions like grasp and opposition within 3 months. Conclusion: Postburn syndactyly, webspace scar contracture and claw hand are the most common functional limiting sequela of burned hands. Restoration of range of motion of hands may take much effort and multiple revision surgeries are usually required to reach satisfactory outcome. Instead of free tissue transfer plus repetitive local flap surgeries, we would like to share an innovative procedure, which emphasize sufficient scar release in concomitant with adequate skin coverage for wide and radical scar contracture on hands. One stage reconstruction with full-fist position outcome provide the advantages including lower anesthesia risk, less donor side morbidity, satisfactory aesthetic outcome, and better cost effectiveness

Purpose: Twenty-five years after the first hand transplant, the procedure is offered at many major academic medical centers and has been performed in patients as young as 8-years-old. A child's inability to weigh the tradeoffs for him/herself requires the deployment of the Best Interest standard and the Harm Principle, aiming either to maximize good or to not place the child at significant and preventable harm. Hand transplants in an immunocompetent child require the initiation of immunosuppressants, which have substantial health implications, including organ failure and early death. Methods: A review of the literature was performed to identify current evidence on outcomes for hand transplants in both children and adults, in addition to immunosuppressant sequelae. Clinical ethics principles were applied to the current evidence.
Results: At the current time, only two pediatric hand transplants have been performed-one in a twin and the other in a child already on immunosuppressants. Thus, any benefits to the child have yet to be shown, and current publications use adult-specific data to make ableist arguments that otherwise healthy children would benefit from a hand transplant despite immunosuppressants' clear harm. Current literature suggests that limb functionality appears improved as compared to pre-transplantation function, in adults. Yet, psychosocial implications in the pediatric transplant population are complex with both benefits and harms. Conclusions: We determine that hand transplants should not be performed in children who would require the initiation of immunosuppressants for the following reasons: (1) Immunosuppressants have immediate and long-term morbid consequences, and (2) long-term outcomes of pediatric hand transplants remain unknown. As there is not a finite window for a hand transplantation, and the risks to children are so great, only adults should be permitted to decide to do transplantation if immunosuppression initiation is required.

Background: Upper extremity (UE) acute compartment syndrome (ACS) requires emergent fasciotomy to avoid irreversible sequelae. While trauma is the most common cause of ACS, atraumatic etiologies require a high index-of-suspicion. We evaluated indications and outcomes of UE fasciotomies to better understand this rare but critical diagnosis.

Methods: All patients who underwent forearm fasciotomy at a single institution were retrospectively reviewed from 2007-2022. Demographics, patient comorbidities, etiology and surgical details were gathered. Primary clinical outcomes included complication rates, secondary surgeries, and death.

Results: 46 forearm fasciotomies were performed during the study period. Common fasciotomy indications were: traumatic arterial catheterization (24%), trauma (17%), prophylactic release (15%) and peripheral intravenous extravasation (15%). Compartment pressures were measured in 9% of patients. 39% (n=18) of patients underwent skin closure at the index operation, whereas 61% (n=28) were treated with secondary closure. Reoperation rate following fasciotomy was 41% (n=19), all of which were in the secondary closure cohort. UE fasciotomies in non-traumatic etiologies were associated with higher mortality when compared to traumatic etiologies (18.4% vs 0%). Elevated lactate levels were significantly associated with mortality on both continuous and categorical analyses (p=0.024 and p=0.003 respectively).

Conclusion: Accurate and timely management of UE ACS remains critical. ACS should be acknowledged as a potential risk of arterial catheterization procedures. Primary closure of fasciotomy sites in appropriately selected cases can safely reduce the number of secondary surgeries. The mortality risk after atraumatic UE ACS should be used to counsel patients.

Introduction: brachial plexus injuries may cause devastating deficits in the upper extremity, with functional, occupational, and social sequelae for lifetime. Within nerve reconstruction treatments, contralateral C7 (CC7) nerve transfer is one of the most encouraging because of its great power of neurotization due to its more myelinated nerve fibers,(1) wide variety of possible functional recovery objectives, and even different surgical techniques, as the retroesophagus route described to shorten the distance between the C7 root and nerve target often obviating the need for nerve grafts.(2) However, its effectiveness and donor morbidity reported by current literature are still confusing with very little reports coming from developing countries that as we know may carry significant access barriers and impact final results.(3) Our purpose is to describe in detail our technique and share our experience employing it.

Methods: Our series consists of 61 patients with preganglionic upper brachial plexus injury who underwent CC7 nerve transfer using a retroesophagus tunneling technique in a center from Medellin (Colombia) since January 2000 with a minimum of follow-up of 5 years and a maximum of 17 years, with a systematic electrodiagnostic and physical evaluation using Medical Research Council–based (MRC) outcome scale for motor function in all cases.

Results: There was a total of 61 patients, from which 55 (90.2%) achieved at least MRC grade M3 to M4 motor recovery for shoulder abduction or flexion, or elbow flexion, and 6 patients (9,8%) only obtained MRC grade M2 motor recovery in shoulder abduction. We observed sensitive recovery in some patients but it was not reproducible in most patients from our series. Regarding donor morbidity, we had a case of neuropraxia for wrist and finger extension, and sensory symptoms in 3 patients, that resolved spontaneously. Finally, respecting complications, dysphagia was identified in 15 patients, but we performed esophagus studies without finding significant changes in their anatomy; we also had a case of subclavian vein trauma requiring reconstruction with a saphenous graft and a patient that required to be explored because of a hematoma.

Conclusion: Traumatic injuries to the brachial plexus tend to be very disabling, the surgeon can directly influence the overall result but it is unpredictable to ensure a functional restoration; access to physical rehabilitation and patient cooperation are also critical definitive factors, especially in cases of nerve transfers. Despite all this, today we can be more optimistic than before regarding the treatment of this pathology even in developing countries, and the CC7 nerve transfer, using a retro esophagus tunnel, is a safe and effective manner for motor and sensitive restoration.

1. Chuang DC. Neurotization procedures for brachial plexus injuries. Hand Clin. 1995;11(4):633-645.
2. Mcguiness CN, Kay SP. The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries. J Hand Surg Br. 2002;27(2):159-160. doi:10.1054/jhsb.2001.0665
3. Yang G, Chang KW, Chung KC. A Systematic Review of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury: Part 1. Overall Outcomes. Plast Reconstr Surg. 2015;136(4):794-809. doi:10.1097/PRS.0000000000001494

Background: Activation of T-helper (Th) inflammatory responses is an established pathophysiology concept for the development of secondary lymphedema (LE). However, recent evidence of an oligoclonal T-cell response in sequenced biopsy samples from LE patients, demonstrates a repertoire of T-cell receptors (TCR's) that recognize the self-antigen, insulin, suggesting that some patients should be classified as suffering from an autoimmune disorder rather than merely an autoinflammatory condition. The hypothesis of an autoreactive component to secondary LE is influenced by several factors: 1) single nucleotide polymorphisms (SNPs) in human leukocyte antigen (HLA) class I and II predict a higher risk of podoconiosis, a form of secondary lymphedema; 2) evidence from a large retrospective study found that LE development following axillary lymph node dissection (ALND) is significantly associated with one or more autoimmune diseases; 3) there is a proven pathogenic role of autoreactive T-lymphocytes in the most clinically relevant inflammatory skin diseases. In this study, we investigate the HLA allelic genotypes associated with LE, classify them as either risk-increasing or protective, and identify putative autoantigens with a strong affinity to these LE-associated alleles.
Methods: We conducted a genome wide association (GWAS) study in patients who did or did not develop breast cancer-related lymphedema (BCRL) following ALND. Two models were run: 1) the allelic model tested the odds of lymphedema in the presence of each HLA allele; 2) the genotypic model tested the odds of lymphedema among patients having a given HLA genotype compared to those that did not have that genotype. Using a validated HLA database, we mapped the alleles of interest to the highest affinity epitope. Results: In the allelic model, the HLA class I significantly associated with LE was HLA-A-02:05 (OR 1.66, 95% CI 1.02-2.71, p=0.043). The HLA class II's with the highest association included HLA-DQB1-3:02 (OR 1.66, 95% CI 1.02-2.71, p=0.043) and HLA-DRB1-08:04 (OR 1.65, 95% CI 1.00-2.70, p=0.046). In the genotypic model, HLA-B-07:02 (OR 1.59, 95% CI 1.05-2.40, p=0.028) and HLA-DQA1-05:01 (OR 1.63, 95% CI 1.04-2.55, p=0.034), were among the most significant HLA class I and class II's, respectively. All three alleles were presented at similar proportions in patients that developed LE and absent in patients that did not develop LE. In the allelic model, HLA-B-44:02 (OR 0.78, CI 0.63-0.96, p=0.020) was expressed at a significantly higher proportion (n=17; n=6) in patients that did not develop disease when compared to patients who did. Allelic-epitope mapping of the risk increasing alleles, HLA-DQB1-03:02 and HLA DQA1-05:01, demonstrates a high affinity to autoantigens insulin and myelin basic protein. Mapping was inconclusive for HLA-DRB1-08:04. Conclusion: The role of T-cell immune responses in triggering LE development has been demonstrated in clinical specimens and mouse models. Only recently, has there been insight into the putative antigens activating these responses. Identification of an HLA, LE- risk allele is provided as evidence for an antigen-driven, possibly autoimmune pathogenesis to LE development. Additionally, it provides a unique potential to develop HLA-dependent immunotherapies to prevent progression of lymphedema.

Introduction Injection-related pain can cause anxiety and discomfort for patients. Vibration devices have been proposed as a potential method for reducing injection-related pain. However, its effectiveness has mostly been studied in dental or facial procedures, and little is known in upper extremity injections. Our study aimed to assess the effectiveness of vibration stimulation on post-injection pain following upper extremity injections. Methods This single-blinded, randomized controlled trial included patients aged 18 years or older who were scheduled to receive an injection in the upper extremity. A total of 60 patients were enrolled and randomized to either the intervention group or the control group using a computer-generated randomization sequence. Level of satisfaction and pain levels were assessed using a visual analog scale (VAS). The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board. Results The mean pain score immediately after the injection was 4.03 ±2.11 out of 10 in the Vibration group (n = 30), compared to 7.4 ±1.37 out of 10 in the Control group (n = 30) (p<0.001). Patients in the Vibration group also reported higher levels of satisfaction and comfort during the injection (p<0.001). No adverse events were reported in either group. Conclusion Our study proves that using a vibration device during upper extremity injections can effectively reduce post-injection pain and improve patient satisfaction. Further research is needed to explore the long-term effects and feasibility of this intervention in different clinical settings.

Purpose: Open reduction and fixation of perilunate injuries (PLIs) has been described using a dorsal, volar, or combined dorsal and volar approach. This systematic review assesses the effect of approach on clinical outcomes in the open treatment of PLIs. A secondary aim is to assess patient-reported outcome (PRO) measures in the evaluation of PLIs.

Materials & Methods: A systematic review was performed from January 2001 to January 2023 to identify original studies describing clinical and patient-reported outcome measures following open treatment of PLIs. Collected variables included patient demographics, surgical characteristics, time of immobilization, flexion-extension arc, scapholunate (SL) interval, and PRO scores. All included studies were independently evaluated using Methodological Index for Non-Randomized Studies (MINORS) non-comparative study criteria.

Results: Sixteen studies met inclusion criteria; all studies were case series. MINORS scores for included studies ranged 8-11 points, demonstrating moderate quality. A total of 249 patients (94.8% male) were included in the analysis: 165 had a dorsal approach, 28 had a volar approach, and 56 had a combined approach. Average age was 33.8±3.7 years. Average time of immobilization was 8.2±2.1 weeks. Average follow up was 20.4±20.7 months (6-288 months). Flexion-extension arc significantly differed between all groups, with an average arc of 85.2° in the combined group, 96.8° in the dorsal group, and 110.6° in the volar group (p<0.001). SL interval was larger in the combined group (2.1±0.3 mm) compared to the volar group (1.7±0.3 mm, p = 0.03) but did not differ between any other approaches. Disabilities of the Arm, Shoulder, and Hand scores were significantly higher in the combined group (37.9 points) compared to both the dorsal and volar approaches (24.0 and 24.7 points, respectively, p<0.001). Modified Mayo Wrist scores were lowest in the combined group (67.9 points), which significantly differed from the dorsal and volar groups (70.5 and 72.4 points, respectively, p<0.001).

Conclusions: Patients with PLIs have significant deficits in flexion-extension arc that may significantly affect activities of daily living, particularly in the combined approach group. PRO measures also demonstrate higher pain and disability with the combined approach. An isolated volar or dorsal approach to PLIs results in improved wrist range of motion and PROs compared to a combined volar/dorsal approach.

Purpose: When distal radius fracture (DRF) patients seek care at community healthcare facilities in our area, they often have delayed presentation to our academic medical center with inadequate or no attempt at closed reduction. The primary aim of this retrospective cohort analysis was to determine if a patient's location of initial presentation to a community or academic provider predicted surgical intervention.

Methods and Materials: We included consecutive patients of all ages who sustained a DRF and presented to our academic medical center or neighboring community providers over a one-year period. Three patients were excluded due to insufficient information on fracture management. A manual chart review was performed to collect data on demographics, location of initial encounter, and fracture management for all patients.

Results: A total of 1,038 DRFs were included. The mean age at the time of presentation was 36.2 years (26.4), and 57.4% of patients were female. When comparing patients who had initial clinical encounters with academic providers to those with community providers, surgical intervention was higher in the community sub-group (26.8%) than the academic sub-group (16.6%) (p = 0.001). There were no significant differences in age (p = 0.868), sex (p = 0.561), fracture type (p = 0.398), or open or closed fractures (p = 0.204) between the community and academic sub-groups. Multivariable logistic regression revealed that seeking care with a community provider is a significant predictor of surgical intervention (OR 1.80; [95% CI: 1.29 – 2.52], p = <.001, AUC = 0.760).

Conclusion: While controlling for age, sex, and fracture characteristics, patients still had a higher likelihood of surgical intervention when presenting to a community provider compared to an academic medical center. Education efforts on reduction techniques with community providers may help prevent unnecessary surgeries.

Background: Socioeconomic disparities pose a significant barrier to clinical follow-up for patients who sustain upper extremity fractures. The area deprivation index (ADI) is a recently developed, comprehensive metric that estimates these disparities at the neighborhood level. The aim of this retrospective cohort study was to assess if the ADI is associated with follow-up non-adherence, and secondarily, determine the individual-level socioeconomic factors associated with follow-up non-adherence after treatment of distal radius fractures (DRF).

Methods: We included all patients who underwent non-operative and operative management of DRF at an academic level I trauma center between 2019 and 2021. A manual chart review was performed to collect data on ADI, sociodemographic factors, injury characteristics, conservative and surgical interventions, and healthcare utilization.

Results: There was a significant, weak negative Spearman-ranked correlation between ADI state deciles and clinic attendance rates (rs(220) = -.144; [95% CI: -.274, -.009] p = .032). Socioeconomic factors associated with significant differences in clinic attendance rates were having a spouse or partner (protective) (p = .007), Medicaid insurance (p = .013), male sex (p = .023), and current smokers (p = .026). Factors associated with differences in no show rates were having spouse or partner (OR .326; [95% CI: .123 – .867] p = .025), Medicaid insurance (OR 7.78; [95% CI: 2.15 – 28.2] p = .002), male sex (OR 4.09; [95% CI: 1.72 – 9.74] p = .001), and cigarette use (OR 5.07; [95% CI: 1.65 – 15.6] p = .005).

Conclusions: ADI has a weak, negative correlation with clinic attendance rates following DRF treatment. Significant disparities in clinic follow-up adherence exist between patients with different marital status, insurances, sexes, and cigarette use.