An Economic Analysis of Outcomes and Complications of Treating Distal Radius Fractures in the Elderly

Shauver, Melissa J.; Clapham, Philip J.; Chung, Kevin C.

doi:10.1016/j.jhsa.2011.09.039

Cited by 99 publications

(61 citation statements)

References 28 publications

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“…28 The incidence of DRF is increased in older adulthood [29][30][31] and is positively associated with increased physical activity levels. 3 These global issues underline the need for this review, which aims to summarize the literature reporting on DRF epidemiology, risk factors, and prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of distal radius fractures and factors predicting risk and prognosis

MacIntyre

Dewan

2016

Journal of Hand Therapy

292

190

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Section: Introductionmentioning

confidence: 99%

Epidemiology of distal radius fractures and factors predicting risk and prognosis

MacIntyre

Dewan

2016

Journal of Hand Therapy

292

190

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“…Distal radius fracture (DRF) is one of the most common types of fracture 7,25,31 that can cause substantial pain, disability, 6,14,24,29,30,37 and health care burden. 6 Study shows that more than 640 000 cases of DRF were reported during 2001 in North America, 14 and nearly 372 000 individuals of age 65 years and older sustain DRF every year in the United States.…”

Section: Introductionmentioning

confidence: 99%

Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions

Esakki

MacDermid

Vajravelu

2016

Hand (New York, N,Y.)

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Background: American Academy of Orthopaedic Surgeons (AAOS) distal radius fracture (DRF) clinical practice guidelines (CPG) are readily available to clinicians, patients, and policymakers. International Classification of Functioning, Disability, and Health (ICF) provides a framework for describing the impact of health conditions. The International Classification of Diseases-10th Revision (ICD-10) is a classification system to classify health conditions as specific disease or disorders. The aim of this study is to analyze and describe the scope and focus of the AAOS DRF CPG using the ICF and ICD-10 as a basis for content analysis, and to compare the content of the CPG with the ICF hand core sets as the reference standard. Methods: Established linking rules were used by 2 independent raters to analyze the 29 recommendations of the AAOS DRF CPG. ICD-10 codes were assigned in the same process. Summary linkage statistics were used to describe the results for ICF and the hand core sets. Results: Among the 29 recommendations of the AAOS DRF CPG, 5 meaningful concepts were linked to the ICF codes. Of these, 5 codes appeared on the comprehensive ICF core set and only 3 codes appeared in the brief ICF core set, and 7 conditions were covered in ICD-10 codes. Conclusions: The AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the ICD-10 and ICF. It does not address activity or participation (disability), and is not well linked to key concepts relevant to hand conditions.

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“…Given the widespread problem of rapidly escalating health care costs, the cost of these interventions must be considered, particularly when outcomes are similar between 2 choices. Shauver and colleagues 8 stated that despite the increased price of these implants, cost-utility calculations have shown that from a societal perspective, ORIF is considered a worthwhile alternative to casting. 8 They concluded that there was a slight preference for ORIF compared with casting for faster return to minimally restricted activity.…”

mentioning

confidence: 99%

“…Shauver and colleagues 8 stated that despite the increased price of these implants, cost-utility calculations have shown that from a societal perspective, ORIF is considered a worthwhile alternative to casting. 8 They concluded that there was a slight preference for ORIF compared with casting for faster return to minimally restricted activity. For patients treated surgically, cost and longterm outcomes were similar regardless of fixation type, and as a result the study found that patients showed little preference for one treatment type over the other.…”

mentioning

confidence: 99%

“…For patients treated surgically, cost and longterm outcomes were similar regardless of fixation type, and as a result the study found that patients showed little preference for one treatment type over the other. 8 Looking at VLP more specifically, to our knowledge, only 1 study has compared the cost of VLP to CRPP. Shyamalan and colleagues 9 reported that treatment of a DRF with VLP cost 3 times more than treatment with Kirschner wire fixation (k-wires) and casting (£2212 v. £662).…”

mentioning

confidence: 99%

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Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation

Dzaja

MacDermid

Roth

et al. 2013

CJS

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Background:We sought to compare direct costs and clinical and radiographic outcomes for distal radius fractures (DRF) treated with open reduction internal fixation with volar locking plates (VLP) versus closed reduction and percutaneous pinning (CRPP). Methods:We identified patients with AO-type A and C1 DRFs from a prospective database. Outcomes were assessed at 6 weeks and at 3, 6 and 12 months, and surgical care costs were estimated.Results: Twenty patients were treated with CRPP and 24 with VLP. There were no significant differences in patient-rated wrist evaluation (PRWE) scores between the 2 groups at any time point (mean 16.2 ± 23.1 in the CRPP group v. 21.5 ± 23.6 in the VLP group, p = 0.91). Overall alignment was maintained in both groups; however, there was a greater loss of radial height over time with CRPP than VLP (0.97 mm v. 0.25 mm, p = 0.018). The mean duration of surgery was longer for VLP than CRPP (113.9 ± 39.5 min v. 86.5 ± 7.8 min, p = 0.029), but there were fewer clinic visits (5.2 ± 1.4 v. 7.8 ± 1.3, p < 0.001) and fewer radiographs (7.4 ± 2.7 v. 9 ± 2.4, p = 0.031). The total cost per case was greater for VLP than CRPP ($1637.27 v. $733.91). Conclusion:Based on PRWE scores, VLPs did not offer any significant advantage over CRPP in patients with simple fracture types between 3 and 12 months, but they were much more costly. Whether VLP offers any functional advantage earlier in recovery, thereby justifying their expense, requires further investigation in the form of a prospective randomized trial with a detailed cost analysis.Contexte : Nous avons voulu comparer les coûts directs et l'issue clinique et radiographique du traitement des fractures du radius distal (FRD) au moyen d'une technique de réduction ouverte avec fixation interne par plaques palmaires de stabilisation (PPS) par rapport à la méthode par réduction fermée et enclouage percutané (RFEP).Méthodes : Nous avons recensé les patients victimes d'une FRD de type AO et de type C1 à partir d'une base de données prospectives. L'issue de ces fractures a été évaluée après 6 semaines, puis après 3, 6 et 12 mois et nous avons estimé les coûts des soins chirurgicaux.Résultats : Vingt patients ont été traités par RFEP et 24 par PPS. On n'a noté aucune différence significative entre les 2 groupes quant aux scores d'évaluation des poignets par les patients eux-mêmes, peu importe le moment de l'évaluation (moyenne 16,2 ± 23,1 dans le groupe traité par RFEP c. 21,5 ± 23,6 dans le groupe traités par PPS, p = 0,91). L'alignement global a été maintenu dans les 2 groupes; toutefois, on a observé une diminution plus marquée de la longueur du radius avec le temps dans les cas de RFEP que dans les cas de PPS (0,97 mm c. 0,25 mm, p = 0,018). La durée moyenne de la chirurgie a été plus longue avec la PPS qu'avec la RFEP (113,9 ± 39,5 min c. 86,5 ± 7,8 min, p = 0,029), mais les visites à la clinique et les radiographies ont été moins nombreuses (respectivement, 5,2 ± 1,4 c. 7,8 ± 1,3, p < 0,001 et 7,4 ± 2,7 c. 9 ± 2,4, p = 0,031). Le coût total par cas a...

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An Economic Analysis of Outcomes and Complications of Treating Distal Radius Fractures in the Elderly

Cited by 99 publications

References 28 publications

Epidemiology of distal radius fractures and factors predicting risk and prognosis

Epidemiology of distal radius fractures and factors predicting risk and prognosis

Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions

Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation

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