The economic burden of open tibia fractures: A systematic review

Abstract

Background: Open tibia fractures are a common injury following road traffic collisions and place a large economic burden on patients and healthcare systems. Summarising their economic burden is key to inform policy and help prioritise treatment.Methods: All studies were identified from a systematic search of Medline, Embase and the Cochrane Central Register of Controlled Trials. We included any human with a diagnosed open tibia fracture, following any intervention. The primary outcome was any costs reported or patient return to work status. Secondary outcomes included average length of stay, wage loss, absenteeism and complications such as infection, amputation and nonunion. Data was extracted and we performed a descriptive narrative summary.Results: We reviewed 1,204 studies from our searches. A total of 34 studies were included from 14 different countries. The average age was 37.7 years old and 76% of the patients were male. 6.5% were Gustilo I, 12% Gustilo II and 82% Gustilo III. Initial direct hospitalisation costs were reported to be between £356 to £126,479 with an average length of stay of 56 days (3.1-244). 89% of participants were working preinjury, 60% fully returned to work, 17% returned to work part time or changed profession and 22% did not return to work at one-year. The most common complications reported were 22% infection, 11% nonunion and 16% amputation. Mean follow-up duration for the studies was 25 months. Conclusion:The economic burden of open tibia fractures varies greatly, but it is costly for both hospitals and patients. The current evidence is predominantly from high-income countries (HICs), especially the USA. Further research is required to investigate the costs of open tibia fractures using validated costing tools, especially in low-income countries (LICs), to help inform and direct policy.

Outcomes of Intramedullary Nailing and External Fixation of Open Tibial Fractures

“…We reported a mean EQ-5D-3L index score of 0.76 for those affected by an infected nonunion, comparable with scores for similarly aged participants living with chronic diseases such as HIV (human immunodeficiency virus) and untreated tuberculosis in other LMICs 27,28 . Further, these lower quality-of-life scores are consistent with findings in the literature describing the chronic burden of nonunion and infection complicating open tibial shaft fractures in higher-income countries 29-34 . While it appears that surgical management results in improved outcomes for most participants 15 , a notable minority still experience devastating complications such as infection and nonunion that impact extended quality of life, as shown in this study.…”

“…With 3 to 5-year follow-up after a randomized clinical trial, this study contributes to knowledge about the postoperative course of open tibial shaft fractures managed with surgical treatment with IMN and EF in LMICs. Our data will inform future clinical trials, studies on infection prevention and management, as well as economic analyses of operative fixation strategies for open tibial fractures treated in resource-limited settings 15,34,40 .…”

Use of a trauma registry to drive improvement in the regional trauma network systems in Hawassa, Ethiopia

“…With regard to the management of open fractures, our data show that a large proportion (67%) of these patients remained in the emergency department for more than 24 h (Table 4 ). Although these patients received IV antibiotics in the department, this raises concerns regarding whether or not time to debridement exceeded 24 h. Open fractures are complex injuries that can be associated with debilitating complications such as neurovascular compromise, infection and long-term impact on a patient’s ability to work [ 12 , 13 ]. Early recognition and standardised treatment of these conditions is vital to avoid both short- and long-term sequelae.…”

Treatment of Infected Tibial Metaphyseal Nonunions Using the Ilizarov Method: Protocol for a Prospective Nonrandomized Study

“…The infected nonunion of the tibia is always a challenging problem for the orthopedic surgeon and can pose a substantial burden on both patients and their families [1,2]. According to Schade et al [3], who performed a systematic review on 17,073 patients with open tibia fractures, the rates of infection, nonunion, and subsequent amputation were 22%, 11%, and 16%, respectively, with a total hospitalization cost between £356 (US $440) to £126,479 (US $156,313) and an average length of hospital stay of 56 days. Hendrickx et al [4], in their systematic review of 8110 patients treated with intramedullary nailing for a tibial shaft fracture, reported a nonunion rate of 11% and an incidence of early deep infection of 3%.…”