Implant cost variation in surgically treated distal radius fractures

Doxey, Stephen; Huyke-Hernández, Fernando A.; Robb, Jennifer L.; Bohn, Deborah C.; Cunningham, Brian P.

doi:10.1016/j.jor.2023.04.003

Journal of Orthopaedics

2023

DOI: 10.1016/j.jor.2023.04.003

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Implant cost variation in surgically treated distal radius fractures

Stephen Doxey

Fernando A. Huyke-Hernández

Jennifer L. Robb

et al.

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2024

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Cited by 2 publications

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“…One potential approach involves limiting the number of locking screws utilized during the procedure. 10 The type and placement of screws determine the initial stability of the volar-locked plating construct. 11,12 Specifically, the presence of multiple locking screws in the distal fragment significantly contributes to the overall stability of the fixation.…”

mentioning

confidence: 99%

The Role of Proximal Locking Fixation in Volar Distal Radius Fracture Fixation

Gossett,

Vu,

Reizner

et al. 2024

J Wrist Surg

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Background Volar-locked plating has become a popular treatment option for unstable distal radius fractures. While using locking screws in the distal fragment increases the stability of the fixation, the biomechanical benefits of locking fixation in the proximal fragment have not been definitively established. Purposes This study evaluated the initial mechanical behavior of the volar plating construct with different locking screw configurations in the proximal fragment. Methods Sixteen Sawbones radius models were used. An unstable metaphyseal distal radius fracture was created and fixated with a volar-locked plate. Four different screw configurations in the proximal fragment were tested: all nonlocking screws, locking screw in the distal-most hole, locking screw in the proximal-most hole, and locking screws in both the proximal- and distal-most holes. Initial stiffness, displacement during harmonic loading, and load-to-failure were compared among the three groups. Results The initial stiffness, displacement during harmonic loading, and load-to-failure did not significantly differ among the four proximal screw configurations (p < 0.05). Failure occurred via toggling of the screws in the configuration with all nonlocking screws and through screw breakage or locking mechanism failure in the configurations with locking screws. Conclusions The use of locking screws in the proximal fragment did not significantly affect the initial stability of volar distal radius plating. However, failure modes differed between the nonlocking and locking configurations, consistent with known mechanical properties of locking fixation. Further mechanical studies in cadaveric models and clinical trials are warranted to determine the optimal screw configuration in volar distal radius plating. Level of Evidence To be determined. Biomechanical study on synthetic models.

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mentioning

confidence: 99%

The Role of Proximal Locking Fixation in Volar Distal Radius Fracture Fixation

Gossett,

Vu,

Reizner

et al. 2024

J Wrist Surg

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Generic Volar Locking Plate Use in Distal Radius Fractures: A Prospective Randomized Study to Evaluate Clinical Outcomes and Cost Reduction

Doxey,

Kleinsmith,

Qian

et al. 2024

Hand (New York, N,Y.)

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Background: The purpose of this study was to evaluate differences in 90-day clinical outcomes between patients treated with generic volar locking plates (VLPs) and conventional VLPs in distal radius fractures. Secondary aims included assessing for differences in surgical characteristics and cost between the groups. Methods: From November 2022 to April 2023, a prospective block-randomized study was undertaken in which surgeons alternated between using a generic VLP and a conventional VLP each month. The institution’s chargemaster database was cross-referenced for implant cost. Primary outcomes were 90-day readmission, reoperation, and mortality rates. Secondary outcomes included estimated blood loss, tourniquet time, and implant cost. Results: A total of 66 patients were included. Most were women (n = 61, 92.4%), with an average age of 61.0 ± 11.5 years. There were no significant differences in age, sex, smoking status, AO Foundation/Orthopaedic Trauma Association classification, or tourniquet time between patients who received generic and conventional implants. The average total cost was higher with conventional implants than generic implants($1348.61 ± 100.77 and $702.38 ± 47.83, respectively; P < .001). The largest difference in cost came from pegs and screws that were used ($640.77 ± 90.93 vs $268.47 ± 45.93, P < .001). No patients experienced complications such as readmission, reoperation, or death within 90 days. Conclusions: Total implant cost was lower for procedures where generic VLPs were used. Cost differences between generic and conventional implants are driven by the variable selection of pegs and screws. With no differences in 90-day outcomes, surgeons may consider using generic implants as a way of increasing the value of care delivery.

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Implant cost variation in surgically treated distal radius fractures

Cited by 2 publications

References 24 publications

The Role of Proximal Locking Fixation in Volar Distal Radius Fracture Fixation

The Role of Proximal Locking Fixation in Volar Distal Radius Fracture Fixation

Generic Volar Locking Plate Use in Distal Radius Fractures: A Prospective Randomized Study to Evaluate Clinical Outcomes and Cost Reduction

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