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Surgical management for displaced pediatric proximal humeral fractures: a cost analysis.

Shore BJ, Hedequist DJ, Miller PE, Waters PM, Bae DS - J Child Orthop (2015)

Bottom Line: A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02).The decision analysis revealed that the PPE technique resulted in an average cost saving of $4,502 per patient compared to IMN and $2,066 compared to PPB.This strategy remained cost-effective even when the complication rates with exposed implants approached 55 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Hunnewell 221, 300 Longwood Avenue, Boston, MA, 02115, USA, Benjamin.shore@childrens.harvard.edu.

ABSTRACT

Purpose: The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF).

Methods: A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leaving the pins exposed (PPE) versus leaving the pins buried (PPB). Finally, sensitivity analyses were performed, assessing the cost-effectiveness of each technique when infection rates and cost of deep infections were varied.

Results: A total of 84 patients with displaced PPHF underwent surgical stabilization. A total of 35 cases were treated with IMN, 32 with PPE, and 17 with PPB. The age, sex, and preoperative fracture angulation were similar across all groups. A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02). Surgical time and estimated blood loss was higher in the IMN group (p < 0.001 and p = 0.01, respectively). The decision analysis revealed that the PPE technique resulted in an average cost saving of $4,502 per patient compared to IMN and $2,066 compared to PPB. This strategy remained cost-effective even when the complication rates with exposed implants approached 55 %.

Conclusions: Leaving pins exposed after surgical fixation of PPHF is more cost-effective than either burying pins or using intramedullary fixation.

No MeSH data available.


Related in: MedlinePlus

Preoperative and postoperative Neer–Horowitz classifications for the three treatment groups: intramedullary nailing (IMN), exposed percutaneous pinning (PPE), and buried percutaneous pinning (PPB). No statistically significant changes were seen in the proportions of fracture type across each of the three groups
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Fig2: Preoperative and postoperative Neer–Horowitz classifications for the three treatment groups: intramedullary nailing (IMN), exposed percutaneous pinning (PPE), and buried percutaneous pinning (PPB). No statistically significant changes were seen in the proportions of fracture type across each of the three groups

Mentions: A total of 84 patients were included in our retrospective analysis (age 13.8 ± 2.25 years); 35 cases were treated with IMN, 32 cases with PPE, and 17 cases with PPB. There were no differences in age, gender, Neer–Horowitz classification, and pre/postoperative angulations across the three surgical groups (Fig. 2a, b). A greater proportion of open reductions was seen in the IMN and PPB groups compared to the PPE group (p = 0.03), while a higher proportion of physeal fractures was seen in the PPE group (p = 0.02) (Table 1). A fall or sports-related injury was the most common injury mechanism across all three groups. All patients achieved significant improvements in angulation and Neer–Horowitz score on the final radiograph. The average preoperative angulation was 44.2° compared with 12.4° on the final radiograph (p < 0.001), but there was no significant difference in angulation amongst treatment groups, nor was there a significant difference in the change of angulation between immediate postoperative and final postoperative radiographs between groups (Table 1). All patients went on to achieve clinical and radiographic healing without functionally limiting loss of global shoulder motion compared with contralateral shoulder, pain, or weakness.Fig. 2


Surgical management for displaced pediatric proximal humeral fractures: a cost analysis.

Shore BJ, Hedequist DJ, Miller PE, Waters PM, Bae DS - J Child Orthop (2015)

Preoperative and postoperative Neer–Horowitz classifications for the three treatment groups: intramedullary nailing (IMN), exposed percutaneous pinning (PPE), and buried percutaneous pinning (PPB). No statistically significant changes were seen in the proportions of fracture type across each of the three groups
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340855&req=5

Fig2: Preoperative and postoperative Neer–Horowitz classifications for the three treatment groups: intramedullary nailing (IMN), exposed percutaneous pinning (PPE), and buried percutaneous pinning (PPB). No statistically significant changes were seen in the proportions of fracture type across each of the three groups
Mentions: A total of 84 patients were included in our retrospective analysis (age 13.8 ± 2.25 years); 35 cases were treated with IMN, 32 cases with PPE, and 17 cases with PPB. There were no differences in age, gender, Neer–Horowitz classification, and pre/postoperative angulations across the three surgical groups (Fig. 2a, b). A greater proportion of open reductions was seen in the IMN and PPB groups compared to the PPE group (p = 0.03), while a higher proportion of physeal fractures was seen in the PPE group (p = 0.02) (Table 1). A fall or sports-related injury was the most common injury mechanism across all three groups. All patients achieved significant improvements in angulation and Neer–Horowitz score on the final radiograph. The average preoperative angulation was 44.2° compared with 12.4° on the final radiograph (p < 0.001), but there was no significant difference in angulation amongst treatment groups, nor was there a significant difference in the change of angulation between immediate postoperative and final postoperative radiographs between groups (Table 1). All patients went on to achieve clinical and radiographic healing without functionally limiting loss of global shoulder motion compared with contralateral shoulder, pain, or weakness.Fig. 2

Bottom Line: A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02).The decision analysis revealed that the PPE technique resulted in an average cost saving of $4,502 per patient compared to IMN and $2,066 compared to PPB.This strategy remained cost-effective even when the complication rates with exposed implants approached 55 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Hunnewell 221, 300 Longwood Avenue, Boston, MA, 02115, USA, Benjamin.shore@childrens.harvard.edu.

ABSTRACT

Purpose: The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF).

Methods: A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leaving the pins exposed (PPE) versus leaving the pins buried (PPB). Finally, sensitivity analyses were performed, assessing the cost-effectiveness of each technique when infection rates and cost of deep infections were varied.

Results: A total of 84 patients with displaced PPHF underwent surgical stabilization. A total of 35 cases were treated with IMN, 32 with PPE, and 17 with PPB. The age, sex, and preoperative fracture angulation were similar across all groups. A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02). Surgical time and estimated blood loss was higher in the IMN group (p < 0.001 and p = 0.01, respectively). The decision analysis revealed that the PPE technique resulted in an average cost saving of $4,502 per patient compared to IMN and $2,066 compared to PPB. This strategy remained cost-effective even when the complication rates with exposed implants approached 55 %.

Conclusions: Leaving pins exposed after surgical fixation of PPHF is more cost-effective than either burying pins or using intramedullary fixation.

No MeSH data available.


Related in: MedlinePlus