Are we putting our best foot forward? The effect of insurance type on ankle fracture complications and delays in care: a retrospective two-year analysis.

Abstract

This study investigates the influence of insurance type on delays in surgical management and postoperative complications in patients with closed operative ankle fractures. A retrospective cohort study was conducted using the PearlDiver Mariner database, analyzing 37,706 ankle fracture patients who underwent open reduction internal fixation (ORIF). Patients were grouped by insurance type (Medicaid vs private insurance), and the time from fracture diagnosis to surgery was compared. Complications including hardware infection, revision surgery, mechanical failure, nonunion, malunion, and postoperative wound issues were analyzed within two years post-surgery. A higher proportion of Medicaid patients had surgical delays beyond 10 days from initial presentation compared to privately insured patients (28.6 vs 22.2 %, p < 0.001). Medicaid patients had higher rates of any orthopedic complications (odds ratio (OR): 1.27, 95 % confidence interval (CI): 1.19 - 1.37), including revision ORIF (OR: 1.33, CI: 1.16 - 1.54), mechanical failure (OR:1.24, CI: 1.03 - 1.49), nonunion or malunion (OR: 1.35, 1.17 - 1.55), and posttraumatic arthritis (OR: 1.26, 1.08 - 1.48). Although complications like wound infection and amputation were more frequent among Medicaid patients, these differences were not statistically significant. Medicaid patients experience longer delays in surgical management and higher rates of complications after ankle fractures compared to privately insured patients.