Examining Delays in Definitive Fixation: An Association of Patient Demographics in Orthopaedic Trauma Requiring External Fixation

Background: Disparities in health care continue to affect marginalized populations in the United States, contributing to increased morbidity, mortality, and health care costs. Although disparities have been extensively studied in arthroplasty and spine surgery, there is limited understanding of how they manifest in orthopaedic trauma, where treatment is often emergent. Therefore, to explore associations between patient demographics and orthopaedic trauma care beyond the emergent timeframe, this study investigated timing to care in patients that required acute external fixation followed by staged definitive fixation. Methods: A retrospective review of trauma patients who underwent lower extremity external fixation at a level 1 trauma center from January 2014 to March 2024 was conducted. Data collected included patient sex, race, age, insurance, comorbidities, fracture type (open vs closed), and substance use. Key outcomes were days from admission to external fixation and from external fixation to open reduction internal fixation (ORIF). Negative binomial post hoc testing was used, with significance set at P <.05. Results: A total of 129 patients met the inclusion criteria. There was a significant difference in timing to ORIF between genders ( P = .034) but no significant difference in timing to ORIF between races ( P = .093); no differences were seen in timing to external fixation. After post hoc analysis, only femur fractures showed a significant difference in timing spending 44% shorter time in external fixation ( P = .03). Conclusion: These findings suggest that, following initial stabilization, gender may correlate with the timing of definitive fixation in orthopaedic trauma care. Identifying and addressing disparities is essential to reducing inequities in clinical outcomes and health care utilization. This study highlights the need for further research aimed at understanding and mitigating delays in treatment. Level of Evidence: Level III, retrospective data from single institution.