When Coverage Isn’t Enough: The Sociodemographic Impact on Weight Bearing Progression after Flap Reconstruction for Lower Extremity Open Fractures

Background: Lower extremity (LE) open fractures are difficult wounds to manage, oftentimes requiring flap reconstruction. These procedures involve complex recoveries that impact daily function and quality of life, with early weight-bearing progression as a key milestone in recovery. Few studies have examined how factors influence weight bearing progression in patients undergoing flap reconstruction after traumatic LE open fractures. Methods: All patients >18 years old between 2012 and 2024 who presented with a Gustilo III or higher LE open fracture and underwent flap reconstruction at our level 1 trauma center were analyzed. Individual-level sociodemographic factors assessed included race/ethnicity, age, sex, primary language, insurance status. Neighborhood-level factors including median income, employment rate, and distance from trauma center, were derived from Zip Code Tabulation Areas. Primary outcome was time to weight bearing as tolerated (WBAT). Secondary outcomes included minor complications (not requiring reoperation) and major complications (requiring reoperation). Multivariate analyses were performed. Results: A total of 324 patients were included. Of these, 298 patients (92%) had documented clearance for weight bearing and were included in the WBAT analysis. The median time to WBAT was 88 days (IQR: 55-137). Non-English speaking patients had significantly shorter times to WBAT (exp(β) = 0.66, 95% CI: 0.47–0.92, p = 0.01). No neighborhood-level SES variables were associated with time to WBAT. Minor complications occurred in 9.6% of total patients, and major complications in 27.2%. No individual- or neighborhood- level sociodemographic factors were significantly associated with complication rates. Conclusion: This study unveils the existence of a language influence on weight bearing progression in this patient population. It emphasizes the need to evaluate and improve communication strategies to ensure patient understanding of postoperative protocols influencing recovery milestones. Future research should aim to develop strategies focused on reducing disparities in functional recovery.