Socioeconomic position is associated with surgical treatment of open fractures of the lower limb: results from a Swedish population-based study

Background and purpose — High-energy trauma to the lower limbs can result in open fractures, treated by reconstructive surgery or amputation. We examined whether socioeconomic position is associated with choice of primary treatment.

Patients and methods — We performed a nationwide population-based study using the Swedish National Patient Register to identify all adult patients who between 1998 and 2013 underwent reconstruction or amputation after an open fracture below the knee. Information on socioeconomic position was collected from Statistics Sweden.

Results — Of 275 individuals undergoing surgery after an open fracture below the knee during the study period, the 1st surgery was reconstructive in 58% of the patients and amputation in 42%. The chance of having an initial reconstruction was lower for women than for men (OR 0.5, 95% CI 0.3–0.9), lower with age (OR 0.97, CI 0.96–0.99), and lower for individuals without employment compared with individuals in employment (OR 0.3, CI 0.2–0.5). Primary treatment was in women associated with family composition, whereas in men it was associated with level of education.

Interpretation — Choice of primary treatment after open fracture in the lower limb is affected by socioeconomic position including sex, age, employment, family composition, level of education, and income.