Cost of external fixationvsexternal fixation then nailing in bone infection

Abstract

AIM:To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment transfer. METHODS:Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. RESULTS:The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care (surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc .) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM nail. CONCLUSION:Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities. Core tip: Fifty patients with infected nonunion tibia (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. ORIGINAL ARTICLE Observational StudyEarly removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance and health authorities.Emara KM, Diab RA, Ghafar KAE. Cost of external fixation vs external fixation then nailing in bone infection.

Cost-effectiveness of pin-in-fibreglass cast versus Kirschner-Ehmer type I external skeletal fixator in the management of transverse radius-ulna fractures in dogs

“…Globally, the cost of medical care is an important issue (Emara et al, 2015). For the human patients, health authorities and insurance system keep asking the medical community about the cost effectiveness of different medical and surgical procedures (Dall et al, 2013).…”

“…Although, the use of simple external fixations are becoming more and more popular for the treatment of fractures in animals, their potentials have not been fully maximized due to the fact that the current commercially available external fixation devices are complex and expensive (Goh et al, 1997, Bada et al, 2017. The cost of treatment and medical care is an important issue all over the world (Emara et al, 2015). Furthermore, with worsening global economy and the poverty inherent in low earning economies in the third world countries, economic considerations have always remained a major determinant factor in the choice of treatment (Onche & Igo, 2005).…”

“…Not only the cost of surgery, wound dressing, physiotherapy etc. is of utmost concern to pet owners (Emara et al, 2015), there is also the economic burden on the dog owners due to days of absence from work of their dogs (e.g breeding stud, sniffer dogs, and guard dogs). Cost analytical studies of various surgery treatment modalities in humans have been published by several researchers (Buechsenschuetz et al, 2002;Onche & Igo, 2005;Emara et al, 2015).…”

“…is of utmost concern to pet owners (Emara et al, 2015), there is also the economic burden on the dog owners due to days of absence from work of their dogs (e.g breeding stud, sniffer dogs, and guard dogs). Cost analytical studies of various surgery treatment modalities in humans have been published by several researchers (Buechsenschuetz et al, 2002;Onche & Igo, 2005;Emara et al, 2015). They documented that the most important factors contributing to the cost of treatment were the cost of surgical implants, instruments, and duration of treatments, which have been reported to be significantly higher in operative than conservative managements.…”

One-Stage Versus Two-Stage Protocol in Management of Infected Nonunited Fracture Femur; Randomized Controlled Trial

“…Both groups had comparable results, but the patients with a change to an intramedullary (IM) nail experienced fewer restrictions [13] . Early conversion to IM nailing may be more costeffective than completing the treatment with an external device [14] . A 27% risk for reintervention due to remaining problems of non-union or recurrence of infection is reported.…”