Clinical and socioeconomic factors associated with return-to-work after upper and lower limb fractures

Fractures of the upper and lower limbs often result in prolonged work absence and significant psychosocial consequences. However, evidence on predictors of return-to-work (RTW) and associated outcomes remains limited. This study aimed to examine return-to-work rates and associated clinical and socioeconomic factors among injured workers in Taiwan with upper or lower limb fractures. This was a retrospective observational study of 360 employed adults with a single upper or lower limb fracture treated at a medical center between 2018 and 2020. Participants completed structured questionnaires assessing demographic, clinical, psychological, and occupational variables. The primary outcome was RTW at the original workplace. Logistic regression identified factors associated with failure to RTW, and linear regression assessed its impact on psychological and physical health. About 14% of the 360 participants did not return to their original workplace. Lower limb fractures (adjusted odds ratio aOR = 2.42, 95% confidence interval CI: 1.22–4.82), working part-time (aOR = 10.09, 95% CI: 4.05–25.12) or temporary employment (aOR = 5.44, 95% CI: 1.80–16.45), prolonged hospitalization, and lower income were independently associated with failure to RTW. Participants unable to RTW reported significantly higher levels of anxiety, depression, post-traumatic stress symptoms, perceived injustice, and poorer quality of life compared to those who RTW. Both clinical and socioeconomic factors substantially influence RTW after limb fractures. Vulnerable workers, particularly those in non-permanent or low-income jobs, require targeted rehabilitation and vocational support to improve reintegration outcomes and mitigate adverse psychosocial effects. Not applicable.