Coronal plane fractures frequently occurred in association with high-energy supracondylar-intercondylar distal femoral fractures; in the present study, the prevalence of associated coronal plane fractures was 38%. The lateral condyle was involved more frequently than the medial condyle was. Coronal plane fractures of both condyles were observed commonly, and the majority of coronal plane fractures were associated with open wounds. Since the surgical tactic for the treatment of a supracondylar-intercondylar distal femoral fracture may be altered by the additional diagnosis of a coronal plane fracture component, preoperative computerized tomographic scanning of the injured distal part of the femur, particularly when there is an associated open wound, is strongly recommended.

Using a standardized technique, appropriate and reliable fluoroscopic landmarks are available in the vast majority of percutaneous iliosacral screw fixation procedures. Iliosacral screw placement without neurodiagnostic monitoring has a low rate of neurologic complications.

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Objectives:To compare economic outcomes in a real-world study of patients with fracture nonunion receiving non-invasive electrical bone growth stimulation (EBGS), low-intensity pulsed ultrasound stimulation (LIPUS), or other non-stimulation fracture management interventions (No-stim). Methods: Medical and pharmacy claims from a US commercially-insured population were analyzed to select adult patients newly diagnosed with a fracture nonunion between July 2006 and September 2009. The date of initial nonunion diagnosis was set as the index date. Three cohorts were constructed based on the first treatment prescribed post index date: EBGS, LIPUS, or No-stim. Baseline demographics, clinical characteristics, and health care costs 9 months before and 1 year after the index date were assessed. Multivariate regression analyses were performed to compare health care costs between cohorts in the post index period. Results: 11,628 patients (mean age 45.4 years; 45.7% males) with a fracture nonunion were identified within the three treatment groups (EBGS: 29.5%, LIPUS: 12.3%, and No-stim: 58.2%). In the post-index period, EBGS patients were significantly less likely to receive fracture-related treatments when compared to the LIPUS (33.6% vs 42.2%, P , 0.01) and the No-stim (33.6% vs 60.3%, P , 0.01) cohorts. Additionally, after adjusting for demographic and clinical characteristics, the EBGS cohort had significantly lower predicted health careassociated costs 1 year post index date when compared to the LIPUS (mean: $21,632 vs $23,964, P , 0.01) and the No-stim (mean: $21,632 vs $23,843, P , 0.01) cohorts. Furthermore, the predicted fracture-related costs (FRC) of EBGS patients were also significantly lower than the FRC of the LIPUS (mean: $9100 vs $10,255, P , 0.01) and the No-stim (mean: $9100 vs $10,354, P , 0.01) patients. Conclusion: In a real-world setting, EBGS is a more cost-effective fracture nonunion treatment across a variety of fracture locations when compared to LIPUS or No-stim. Fracture nonunion patients receiving EBGS had lower total health care resource use and overall costs as compared to LIPUS or No-stim.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objectives: Diabetic patients can suffer from poor bone quality and impaired vascularity often leading to increased fracture risk, delayed healing and potential fracture nonunion. Therefore, this study assessed healthcare resource utilization by diabetic patients receiving electrical bone growth stimulation (EBGS) versus low-intensity pulsed ultrasound stimulation (LIPUS) or neither (No-stim) for the management of their fracture nonunions. Methods: Diabetic and non-diabetic patients newly diagnosed with a fracture nonunion were identified using medical and pharmacy claims and stratified by the first treatment received after nonunion diagnosis: EBGS, LIPUS, or No-stim. Patient demographics, comorbidities, fracture characteristics, and healthcare costs were analyzed before and after nonunion diagnosis. Multivariate regression analysis was used to compare healthcare costs incurred during nonunion fracture management for the different treatment cohorts. Results: After controlling for demographic and clinical characteristics in the diabetic group, EBGS was associated with significantly lower total healthcare costs when compared with the No-stim cohort

OBJECTIVES: There has been recent controversy regarding the effectiveness of vertebral augmentation (balloon kyphoplasty (BKP) and vertebroplasty (VP)) for treating vertebral compression fractures (VCFs). Limited cost comparisons of BKP and VP suggest that initial hospital costs are higher for BKP (Mehio 2011), however costs for subsequent post-operative care are unknown. The present study sought to characterize and compare the treatment costs for BKP and VP patients through 2 years post-surgery. METHODS: Using the 2005-2009 5% Medicare claims data, BKP and VP patients were identified using ICD-9-CM and CPT-4 codes. Treatment costs (Medicare reimbursement/payment adjusted to June 2011 dollars) were compiled for all components of treatment during the 2-year follow-up. Length of stay (LOS) and treatment costs for BKP and VP patients were compared using logistic regression, adjusting for gender, age, census region, comorbidities (Charlson score), race, socio-economic status (Medicare buy-in status), cancer diagnosis (presence in prior 12 months) and year of surgery. RESULTS: A final cohort of 2878 BKP and 1,609 VP patients was included. LOS was 3.5 ϩ/Ϫ 4.1 days and 5.5 ϩ/Ϫ 4.3 days for BKP and VP patients who had inpatient procedures, corresponding to 43% shorted LOS (adjusted) for BKP (pϽ0.001). There were no significant differences in average adjusted treatment costs for BKP and VP patients within the first 3 (pϭ0.097) and first 6 months (pϭ0.142). For the remaining periods, however, BKP patients had lower adjusted costs (pϽ0.025). At 2 years, the average adjusted costs were 7% lower for BKP (pϭ0.005). CONCLUSIONS: Although BKP and VP patients in the Medicare population were found to have similar treatment costs within the first six months following surgery, BKP was found to be cost saving compared to VP subsequently over time through 2 years.