{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:47:40Z","timestamp":1792068460015,"version":"4.4.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>This study explored the hypothesis that social determinants of health, including racial and economic differences, may impact orthopaedic trauma outcomes in patients undergoing open reduction and internal fixation of humeral shaft fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Single, academic, tertiary level I trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient Selection Criteria:<\/jats:title>\n            <jats:p>Adults with midshaft humerus fractures (Orthopaedic Trauma Association\/Association of Osteosynthesis 12) were treated operatively with plate fixation from May 2011 to May 2021 with a minimum follow-up of 9 months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n            <jats:p>Radiographic fracture healing, complication rates, and patient-reported outcomes were investigated. Social determinants of health were assessed using the Area Deprivation Index (ADI). Demographics, complication rates, and patient-reported clinical outcomes were compared between the first and fourth ADI quartiles.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>One hundred ninety-six patients fit the study criteria. The average age of the cohort was 47 years with 100 women (51%). Comparisons of the least deprived quartile (n = 49) with the most deprived quartile (n = 49) yielded similar sex distribution (59% vs. 43% females, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.15), fewer non-White patients (8% vs. 51%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01), older average age (51 vs. 43 years, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.05), similar body mass index (30.5 vs. 31.8, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.45), and higher Charlson Comorbidity Index (2.2 vs. 1.1, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.03). While nonunion rates were similar (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.20) between groups, the most deprived quartile had 2.3 times greater odds of postoperative complications (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04). Patients in the most deprived group exhibited higher Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01) and PROMIS Depression (D) scores (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.01), with lower PROMIS Physical Function scores (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01) at 6-month follow-up than the least deprived cohort. The most deprived cohort had 3 times higher odds of missing scheduled appointments within the first postoperative year (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01), resulting in a significantly higher no-show rate (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01) than the least deprived cohort. Regression analysis including several demographic and injury factors identified that ADI was significantly associated with the occurrence of any missed appointments (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01), no-show rates (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04), and experiencing one of the following postoperative complications during recovery: nonunion, radial nerve injury, or dysfunction (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.03).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Patients experiencing greater resource deprivation faced increased odds of complications, missed appointments, and poorer PROMIS outcomes following humeral shaft fracture fixation. These findings suggest that baseline socioeconomic disparities predict unfavorable postoperative outcomes even given favorable baseline health status according to the Charlson Comorbidity Index score.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002878","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:21:59Z","timestamp":1722558119000},"page":"629-634","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Greater Socioeconomic Deprivation Is Associated With Increased Complication Rates and Lower Patient-Reported Outcomes Following Open Reduction and Internal Fixation of Humeral Shaft Fractures"],"prefix":"10.1097","volume":"38","author":[{"given":"Urvi J.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Physical Performance, University of Rochester Medical Center, Rochester, NY; 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