Objectives: Racial disparities in elective treatments have been documented but is less known within urgent care. Our study compared healthcare utilization in surgically-treated tibial fracture cases among race/ethnic groups.

Methods: Patients within IBM® MarketScan® Medicaid database with tibial fracture and surgical intervention (date of surgery = index) from 10/1/2015 to 12/31/2020 and ≥ 6 months of continuous enrollment pre-index were identified. Exclusion criteria included: polytrauma, amputation at index, fractures pre-index, race other than Black or White. Variables included patient demographics, comorbidities (defined by Elixhauser Index (EI)), fracture types (open vs closed, Gustilo I-II vs III), procedural characteristics (surgery type, implant type used). Black vs White patients were matched using propensity scores on age, gender, surgical procedures, fracture type, and comorbidities. Outcomes included post-surgical treatment (pain medication use, reoperations) and complications (infection, nonunion) up to 2 years post-index. Chi-square tests and survival analyses (Kaplan-Meier and Cox regression) were conducted.

Results: 6,280 matched patients (3,140 White, 3,140 Black) were analyzed (48.2% female, average age 40.3 (standard deviation (SD): 18.7), 17.7% <19 years, average EI 2.2 (SD: 2.6), closed fracture: 70.5%, 59.0% shaft and 28.6% comminuted fractures). 52.1% were treated with internal fixation, 19.6% external fixation and 25.4% intramedullary nails. Blacks were significantly less likely to have a reoperation (hazard ratio: 0.88, 95%CI: 0.80-0.97, p= 0.01) but complication rates were not statistically different between Black and White patients. Whites were significantly more likely to be prescribed antibiotics, strong opiates, and antidepressants (Patients with ≥ 1 prescription at 12-months, for antibiotics: 66.7% White, 54.6% Black, difference: 12.1%, p<0.001; for antidepressants: 41.9% White, 29.0% Black, difference: 12.9%, p<0.001; for strong opiates: 10.4% White, 6.4% Black, difference: 4.0%, p<0.001).

Conclusions: Although complication rates were similar between Black and White patients, treatments, such as reoperation and medication prescriptions, differed.