Volar locking plates versus Kirschner wires for distal radial fractures—A cost analysis study

Shyamalan, G.; Theokli, Chris; Pearse, Yemi; Tennent, Duncan

doi:10.1016/j.injury.2009.02.018

Cited by 59 publications

(38 citation statements)

References 5 publications

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“…It has been argued that in the absence of convincing evidence of superiority of volar locking plates, economic considerations should drive clinical decision-making and policy in the treatment of dorsally displaced distal radius fractures [8,9,40]. However, a robust economic analysis will need to consider differences in costs associated with complications (eg, antibiotic treatment for superficial infections) in addition to differences in costs of the implants, length of surgery, requirement for adjunctive treatments (eg, external fixation, casting), and postoperative protocols (eg, clinic visits, radiographs) [8].…”

Section: Discussionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Distal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior. Questions/purposes We performed a meta-analysis of randomized controlled trials to determine whether patients treated with volar locking plates (1) achieved better function (2) attained better wrist motion, (3) had better radiographic outcomes, and (4) had fewer complications develop than did patients treated with K-wires for dorsally displaced distal radius fractures. Methods We performed a comprehensive search of MEDLINE (inception to 2014, October Week 2), EMBASE (inception to 2014, Week 42), and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials; we supplemented these searches with manual searches. We included studies of extraarticular and intraarticular distal radius fractures. Adjunctive external fixation was acceptable as long as the intent was to use only K-wires where possible and external fixation was used in less than 25% of the procedures. We considered a difference in the DASH scores of 10 as the minimal clinically important difference. We performed quality assessment with the Cochrane Risk of Bias tool and evaluated the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Seven randomized trials with a total of 875 participants were included in the meta-analysis. Results Patients treated with volar locking plates had slightly better function than did patients treated with K-wires as measured by their DASH scores at 3 months (mean difference [MD], 7.5; 95% CI, 4.4-10.6; p \ 0.001) and 12 months (MD, 3.8; 95% CI, 1.2-6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7°[95% CI, 0.3°-7.1°; p = 0.04] and 4.1°[95% CI, 0.6°-7.

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Section: Discussionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The PRWE is a reliable, valid measure RECHERCHE of patient-rated pain and disability. 9 Secondary outcomes included range of motion and grip strength. Patients were evaluated prospectively at 6 weeks and at 3, 6 and 12 months postoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…To date, the only known cost analysis of treating DRFs is the one performed by Shyamalan and colleagues. 9 They reported that treatment of a DRF with VLP cost 3 times more than treatment with CRPP and casting (£2212 v. £662). 9 Similarly, our estimations demonstrate that treatment with VLP fixation more than doubles the cost associated with CRPP ($1217.27 v. $509.89).…”

Section: Cost Estimation Of Closed Reduction With Percutaneous Pinninmentioning

confidence: 99%

“…9 They reported that treatment of a DRF with VLP cost 3 times more than treatment with CRPP and casting (£2212 v. £662). 9 Similarly, our estimations demonstrate that treatment with VLP fixation more than doubles the cost associated with CRPP ($1217.27 v. $509.89). Shyamalan and colleagues focused on a cost analysis and did not include clinical or radiographic outcomes, an important weakness of their study.…”

Section: Cost Estimation Of Closed Reduction With Percutaneous Pinninmentioning

confidence: 99%

“…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). 9 Unfortunately, their study had a small sample size (n = 20), was retrospective and did not include any clinical or radiographic outcomes, making it difficult to put the cost comparison into context.…”

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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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Internal fixation versus other surgical methods for treating distal radius fractures in adults

Jariwala

Phillips

Storey

et al. 2014

Cochrane Database of Systematic Reviews

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Volar locking plates versus Kirschner wires for distal radial fractures—A cost analysis study

Cited by 59 publications

References 5 publications

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

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

Internal fixation versus other surgical methods for treating distal radius fractures in adults

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