Intramedullary Implant Choice and Cost in the Treatment of Pediatric Diaphyseal Forearm Fractures

Heare, Austin; Goral, Dawn; Belton, Matthew; Beebe, Corey; Trizno, Anastasiya A; Stoneback, Jason W

doi:10.1097/bot.0000000000000925

Cited by 16 publications

(12 citation statements)

References 31 publications

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“…Our results show that intramedullary nailing of upper limb fractures using TEN is more expensive than other fracture stabilization methods. These results are consistent with those of previous studies [15][16][17][18].…”

Section: Discussionsupporting

confidence: 94%

“…This is the standard of care in many hospitals around the world [3,5,19,20]. Furthermore, modifications to the intramedullary nailing technique were introduced by several authors: Some of the authors routinely use a single nail stabilizing both the forearm bones, with comparable results to using the classic two nail insertion technique, or recommend careful consideration when choosing the surgical technique and materials for fracture stabilization [18,23]. On the other hand, when trying to reduce the cost, the entire picture, and not only the cost generated by the inpatient treatment, has to be considered.…”

Section: Discussionmentioning

confidence: 99%

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Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

et al. 2020

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Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

et al. 2020

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“…5 In addition to complication rates, the cost to the patient and healthcare system as a whole must be considered when deciding on the optimal treatment of pediatric forearm fractures. 13,16,17 The current study demonstrated a significant amount of baseline variation among orthopaedic surgeons who treat pediatric forearm fractures. With regards to surgeon demographics, there was no statistically significant difference in treatment preferences associated with age, years in practice, and fellowship training among the surgeons that responded to the survey.…”

Section: Discussionmentioning

confidence: 81%

Variations in the Preferred Treatment of Pediatric Forearm Fractures Among Practicing Orthopaedic Surgeons

Patel¹,

O’Hara²,

Giampaolo³

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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Background: Forearm fractures are common childhood injuries. Controversy remains on the optimal treatment for certain fractures. The goal of this study was to determine variation in the treatment of pediatric forearm fractures based on fracture patterns, patient demographics, and surgeon characteristics. Methods: A survey was distributed to orthopedic surgeons consisting of 48 different cases of pediatric forearm fractures with possible treatment options. Each case included patient age and radiographs at three different time intervals: initial injury, post reduction, and first office follow-up. Respondents were asked if they would recommend non-surgical management, surgery with intramedullary nailing, or surgery with plate/screw fixation. Surgeon demographic data was also collected. The primary model investigated the effect of the attributes on the surgeon’s decision to operate. Results: 48 of 55 surgeons responded. Surgery was chosen as preferred treatment in 43% of the presented scenarios. Coronal plane angulation at first follow-up was associated with the greatest increase in marginal probability of operative treatment. For each degree increase in angulation, respondents were 5.2% more likely to operate on a patient. For each additional year of patient age, operative treatment probability increased by 3.9%. Surgeons’ sex, age, years in practice, and fellowship type were not associated with variations in treatment preferences. Conclusions: Our study demonstrates significant variability in treatment recommendations amongst orthopedic surgeons with regard to pediatric forearm fractures. Patient age and coronal plane angulation at first follow-up increased the probability of choosing operative treatment among respondents. Surgeon characteristics did not predict treatment recommendations.

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“…Finally, TENs have been shown to cost 26.6 times more than a K-wire per implant. 6 Coupled with the cost of return to theaters, the difference is significant.…”

Section: Expected Outcomesmentioning

confidence: 99%

A Cost-effective Technical Tip for Surgical Management of Pediatric Distal Radius and Ulna Fractures at Metadiaphyseal Junction

Tang¹,

As-Sultany²,

Makki³

2020

Techniques in Orthopaedics

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Significantly displaced paediatric distal radius and ulna fractures which occur at the meta-diaphyseal junction frequently require surgical fixation due to the highly unstable configuration. The location of the fracture is often too proximal for transfixing with K-wires and too distal for intra-medullary TEN (titanium elastic nailing). We describe a simple cost-effective technique to stabilise such an injury using a readily available 2mm stainless steel kirschner-wire.

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Intramedullary Implant Choice and Cost in the Treatment of Pediatric Diaphyseal Forearm Fractures

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 16 publications

References 31 publications

Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Variations in the Preferred Treatment of Pediatric Forearm Fractures Among Practicing Orthopaedic Surgeons

A Cost-effective Technical Tip for Surgical Management of Pediatric Distal Radius and Ulna Fractures at Metadiaphyseal Junction

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