Return to Work after Upper or Lower Extremity Long Bone Fractures: Social Factors in a Japanese Multicenter Cohort Study

Introduction: Fractures cause serious impediments to employment. In Japan, there is insufficient evidence regarding social factors, such as nonregular employment, and return to work (RTW) after an injury. This study aimed to determine the association between social factors and RTW following injury. Methods: This multicenter cohort study was conducted from 2015 to 2018 and included 674 patients aged 18-65 years who were workers at the time of injury and underwent surgery for long bone fractures of the upper or lower extremities. The primary outcome was the RTW rate within 2 years following injury. Data on RTW at 6 months, 1 year, and 2 years were collected. Observational data following RTW were not included. The association between RTW at 6 months and within 2 years following injury and social factors were evaluated via logistic regression and Cox proportional hazards regression analyses, respectively, after adjusting for patient- and fracture-related factors. Results: Overall, 525 (77.9%) and 602 patients (89.3%) resumed work at 6 months and within 2 years, respectively, following injury. Physical labor, open fractures, and chronic pain were associated with the RTW at both 6 months and within 2 years. However, nonregular employment and workers' compensation insurance were only associated with RTW at 6 months. Social factors were associated with the RTW rate at 6 months but not within 2 years following injury. Conclusions: Approximately 10% of patients with fractures did not resume work within 2 years following injury. This analysis points to social factors as a risk for delaying early RTW and has implications for interventions at the policy level.