Incarceration Status and Access to Care Following Hand and Wrist Fractures

Background: Incarcerated individuals face well-documented care disparities, but whether these extend to acute upper-extremity trauma is unclear. We evaluated the association of incarceration with specialist evaluation, rehabilitation utilization, and postoperative complications following hand and wrist fractures. Methods: We retrospectively studied consecutive adults treated for hand or wrist fractures at a safety-net level I trauma center from 2018 to 2024, comparing incarcerated with nonincarcerated patients. Key process outcomes included the presence of the first specialist evaluation and the number of documented hand therapy visits. Secondary clinical outcomes included documented postoperative complications among surgically treated patients. Results: Of 1597 eligible patients, 197 (12.3%) were incarcerated and 1400 (87.7%) were nonincarcerated. The incarcerated cohort had a higher prevalence of bipolar disorder (13% vs 4.3%; P < .001), schizophrenia (7.1% vs 2.0%; P < .001), and self-inflicted injury (25% vs 12%; P < .001). First specialist evaluation occurred more often in the outpatient clinic for incarcerated patients (55% vs 18%) and more often in the emergency department for nonincarcerated patients (71% vs 43%; both P < .001). Rates of cross-sectional imaging (16% vs 20%; P = .20) and operative treatment (34% vs 30%; P = .30) were similar. Incarcerated patients completed fewer therapy visits (median, 1.8 vs 3.8; P = .004). Rates of documented postoperative complications did not differ significantly between groups. Conclusion: Incarceration was associated with outpatient rather than emergency-department first specialist evaluation and significantly reduced hand therapy utilization, a pattern suggesting less direct access to timely specialist care. System-level interventions to standardize referral and optimize rehabilitation access are needed to reduce care disparities for this vulnerable population. Level of Evidence: III