Social Determinants of Disability After Orthopaedic Trauma: A Structural Equation Modelling Study of Patients in North Central and North East Nigeria

Disability following orthopaedic trauma is not determined solely by injury severity but is shaped by a complex web of social determinants including socioeconomic status, gender, household composition, access to rehabilitation, and structural health system factors. Despite its clinical and public health relevance, a theoretically grounded empirical investigation of social determinants of post-traumatic orthopaedic disability in Nigeria has not been conducted. This study applies structural equation modelling (SEM) to test a theoretically derived causal model of disability after orthopaedic trauma among adults in North Central (Kogi, Benue, Niger, Plateau) and North East (Gombe, Adamawa) States. Eight hundred adult orthopaedic trauma patients will be recruited at six hospitals at one-year post-injury. The World Health Organisation's International Classification of Functioning Disability and Health (ICF) provides the overarching theoretical framework. Latent variables including socioeconomic disadvantage, household social capital, structural access to rehabilitation, and psychological resilience will be measured using validated instruments and modelled using confirmatory factor analysis before SEM path analysis. The study hypothesises that structural health access barriers and low household social capital have a greater total effect on post-traumatic disability than injury severity. This research generates an original structural causal model of orthopaedic disability applicable to planning community rehabilitation interventions in underserved Nigerian states. Keywords: social determinants, disability, orthopaedic trauma, structural equation modelling, ICF framework.