Treatment of tibial bone defects: pilot analysis of direct medical costs between distraction osteogenesis with an Ilizarov frame and the Masquelet technique

Abstract

Purpose The cost implications of limb reconstruction techniques have not been adequately investigated. Aim of this pilot study was to compare the direct medical cost of tibial bone defects managed with distraction osteogenesis–Ilizarov method (ILF), or with Masquelet technique (MIF). Methods Data of 20 random patients treated in a single centre were analysed. Inclusion criteria included acute tibial defects, or post-debridement of nonunions with complete follow-up and successful union. The endpoint of clinical efficacy was the time-to-defect union. Comparisons were made between equally sized subgroups (ILF vs. MIF). Results The average defect length was 5.6 cm (2.6–9.6 cm). The overall cost of 20 cases reached £452,974 (mean £22,339, range £13,459–£36,274). Statistically significant differences favoring the MIF were found regarding the average time-to-union; number of surgeries, of admissions and follow-up visits, as well as the mean intraoperative cost (£8857 vs. £14,087). These differences lead to significant differences of the mean cost of the overall treatment (MIF £18,131 vs. ILF £26,126). Power analysis based on these data indicated that 35 patients on each group would allow detection of a 25% difference, with an alpha value of 0.05 and probability (power) of 0.9. Conclusions The results and analysis presented highlight factors affecting the high financial burden, even in a best-case scenario, this type of surgery entails. Larger pivotal studies should follow to improve the cost efficiency of clinical practice.

Current Management of Acute and Posttraumatic Critical Bone Defects

“…In addition, their own skill and institutional resources, as well as the patient's psychosocial situation, are critical for success. 5,13 Medical literature on the subject still fails to demonstrate one specific treatment algorithm over another. The Ilizarov method of distraction osteogenesis, Masquelet (inducible membrane) technique, cancellous grafting, vascularized grafting, and custom metallic implant continue to provide successful limb salvage options for patients.…”

“…5 Treatment costs and efficiency of care are important factors that health care providers will continue to use in decision making. 13 Distraction Osteogenesis (The Ilizarov Method) Distraction osteogenesis was developed by Gavril Ilizarov 12,14,15 in the 1950s and included invention of his apparatus, the Ilizarov circular ring fixator. Ilizarov's thesis was on the Law of Tension Stress, which he described a lowenergy osteotomy, bony stability, and distraction with a specific rate and rhythm.…”

“…5 Treatment costs and efficiency of care are important factors that health care providers will continue to use in decision making. 13…”

Induced membrane technique for acute bone loss and nonunion management of the tibia

“…[16] A recent cost-analysis paper comparing the Ilizarov vs the Masquelet technique highlighted the increased overall cost of the former (40% higher cost), related to increased number of surgical procedures, admissions, intraoperative cost, and outpatient clinic follow-up. [17] The Masquelet technique has several advantages, including the local delivery of antibiotics, the creation of a favorable biologic chamber for bone regeneration, and healing time regardless ofthe defect length. [18] Its success rate is very high, around 86% to 89% for mean bone defect size of 6.32 cm (range 2-25 cm), [19,20] with the main complication being deep infection (8%), most likely due to suboptimal surgical debridement.…”

Measuring Bone Healing: Parameters and Scores in Comparison

“…Bone healing, also known as fracture healing, is a complex biological process through which the body repairs and regenerates damaged bone tissue. Detailed knowledge of the biological processes is necessary for the treatment of bone defects [ 1 , 2 , 3 ]. When a bone fractures, whether due to trauma, disease, or surgery, the body initiates a series of events to restore the bone’s structural integrity.…”