Abstract
Orthopedic trauma disproportionately affects vulnerable populations in the United States, yet the influence of social determinants of health (SDOH) on patient outcomes remains underexplored. This scoping review aims to map and evaluate existing literature on the relationship between SDOH and adult orthopedic trauma outcomes in the U.S., with the goal of identifying research trends, gaps, and priorities for future investigation. Following the JBI methodology for scoping reviews and reported according to PRISMA-ScR guidelines, seven databases were systematically searched. Eligible studies included adult patients (≥18 years) treated for orthopedic trauma in U.S. trauma centers and examined outcomes in relation to SDOH domains. From 8,105 initial records, 40 studies met inclusion criteria. The majority employed retrospective designs (70%) and were conducted at single institutions (52.5%). Social and community context (80%) and healthcare access (57.5%) were the most frequently studied SDOH domains, whereas education access and quality was rarely addressed (7.5%). Lower extremity (35%) and hip (22.5%) injuries were most studied, with surgical management predominating (70%). Reported outcomes varied widely, with mortality (32.5%), length of stay (30%), infection (22.5%), and re-operation (22.5%) being most common. This review highlights both the breadth and fragmentation of current evidence, revealing significant gaps in the study of underrepresented SDOH domains and non-surgical trauma care. Future research should prioritize standardized SDOH data collection and increased investigation of non-surgical trauma outcomes in order to inform equitable clinical practice and guide policy in US orthopedic trauma care.