Economic Evaluation of 2 Treatments for Pediatric Femoral Shaft Fractures

Coyte, Peter C.; Bronskill, Susan E.; Hirji, Z.; Daigle-takacs, Ginette; Trerise, Barbara; Wright, James G.

doi:10.1097/00003086-199703000-00029

Cited by 37 publications

(23 citation statements)

References 18 publications

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“…In their billing systems however, in addition to the medical charges to the hospital, physicians comprising the orthopaedists, anaesthesiologists, radiologists were paid separately further increasing the medical bill. This was similar to findings by Coyte 13 who found in his analysis that treatment with spica and traction was cheaper at his centre than external fixation. He attributed this to the cost of the fixator, additional operating room staff cost and other professional and technical fees payable.…”

Section: Introductionsupporting

confidence: 90%

Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment

Onche

Igo²

2006

Nigerian Journal of Surgical Research

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Objective: Economic considerations are an essential part of good surgical practice especially in the face of ever rising cost of health care in a depressed economy. This paper compares the cost effectiveness of compression plating and traction in paediatric femoral shaft fractures. Methods: A-ten-year comparative multi-centre study in which children 5-16 years who had open reduction and internal fixation (ORIF) with dynamic compression plates were compared with children who had conservative management by traction. A cost analysis was done using duration of hospitalization and direct cost as economic indices. Patients were matched for age, sex, area and type of fracture, cause of injury (one case of osteogenesis imperfecta is on record) and indication for surgery. Results: Thirty-one patients who had ORIF and 31 matched controls were recruited from a pool of 775 children who sustained femoral fractures over the study period. There were 42 (67.7%) males and 20 (32.3%) females. Forty-seven (71.0%) resulted from road traffic accidents, 17 (27.4%) from fall from heights and one (1.6%) pathological fracture from osteogenesis imperfecta. The right femur was affected in 34 (54.8%) and the left in 28 (45.2%) cases. The commonest type of fracture was oblique in 30 (48.4%), transverse in 19 (30.6%) and spiral in 13 (21.0%) patients. The mean duration of hospital stay for ORIF was 3.9(±1.7) and 6.4(±1.2) weeks for the conservative group (p<0.001). The mean cost of treatment was N27, 844.00 (±7,600) ($206.03) for ORIF and N17,315.60 (±5,300) ($123.70) for the conservative group( p<0.001). Conclusion.The cost of open reduction and internal fixation with dynamic compression plates and screws is 38% more expensive than conservative treatment using traction in spite of the longer duration of hospitalization. This is accounted for by the cost of implants and antibiotics.

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Section: Introductionsupporting

confidence: 90%

Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment

Onche

Igo²

2006

Nigerian Journal of Surgical Research

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“…There are several different options for treating femoral-shaft fractures in children, including skeletal or skin traction, early or immediate application of a hip spica cast, pontoon spica, closed reduction and minimally invasive plate osteosynthesis, external fixation, plate fixation, and internal fixation with the insertion of intramedullary nails [3, 4]. Selecting the management strategy is dependent on factors such as the presence of other associated injuries or multiple trauma, fracture properties, age, and socioeconomic factors.…”

Section: Introductionmentioning

confidence: 99%

Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children

Shemshaki

Mousavi

Salehi

et al. 2011

J Orthopaed Traumatol

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BackgroundThere is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children.Materials and methodsForty-six children, 6–12 years old, with simple femoral-shaft fractures were randomized to receive skeletal traction followed by hip spica cast (n = 23) or TEN (n = 23). Length of hospital stay, time to start walking with aids, time to start independent walking, time absent from school, parent satisfaction, and range of knee motion were compared between the two groups 6 months after injury.ResultsThe two groups were similar in background characteristics. Compared with the children treated with spica cast, those treated with TEN had shorter hospital stay (P < 0.001) and took a shorter time to start walking with support or independently (P < 0.001), returned to school sooner (P < 0.001), and had higher parent satisfaction (P = 0.003). Range of knee motion was 138.7 ± 3.4° in the spica cast group and 133.5 ± 13.4° in the TEN group (P = 0.078). Three patients (13.0%) in the spica cast group compared with none in the TEN group had malunion (P = 0.117). Postoperative infection was observed in three patients (13.0%) in the TEN group.ConclusionsThe results showed significant benefits of TEN compared with traction and hip spica cast in the treatment of femoral-shaft fractures in children. Further trials with longer follow-ups and comparison of TEN with other methods, such as external fixation, in children’s femoral fractures are warranted.

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“…The use of systemically administered antibiotics to treat pins tract infections declines, as does the need for premature pin removal and replacement in the operating room. Coyte et al [4], reported an additional operative cost of $1330 per patient was directly associated with the removal and replacement of infected pins. This $1330 amount was calculated from patient and financial information gathered from April 1993 to January 1994 and represents a highly conservative figure in comparison to the current cost.…”

Section: Clinical Benejitsmentioning

confidence: 99%

Bactericidal activity of antimicrobial coated polyurethane sleeves for external fixation pins

FORSTER

Marotta

Heseltine

et al. 2004

Journal Orthopaedic Research

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This study was conducted to assess the potential of gentamicin coated polyurethane sleeves to inhibit bacterial colonization on external fixation pins and wires. These antimicrobial sleeves have been designed to be fitted over the pins and wires, at the time of surgery, as a prophylactic approach to combat the major complication of external fixation treatment, pin tract infection. Elution testing was conducted to estimate the amount of gentamicin released into the pin tract. These gentamicin concentrations were compared to the gentamicin minimal inhibitory concentration (MIC) level for common pin tract pathogens. Elution testing revealed that the gentamicin coated polyurethane sleeves released significant quantities of the antibiotic for up to 26 weeks. The initial bolus release was characterized by predicted pin tract gentamicin concentrations of >SO pg/ml at the 2 h and 1 day elution time points. These amounts of gentamicin, delivered directly to the pin tract, are far beyond those that could be achieved via oral or intravenous administration. Furthermore, the expected concentration of gentamicin in the pin tract remained above the National Committee for Clinical Laboratory Standards (NCCLS) MIC breakpoint of 4 pglml, [Performance standards for antimicrobial susceptibility testing: twelfth informational supplement M100-SI2, NCCLS, Wayne, PA, 20021, for at least 20 weeks. Data from the SENTRY antimicrobial surveillance program (1997)(1998)(1999)(2000)(2001)(2002)) established a high level of bactericidal activity for gentamicin, with 83.1% of the common pin tract pathogen isolates found to be susceptible to the antibiotic. The initial burst and subsequent long-term sustained local delivery of effective amounts of gentamicin from the antimicrobial sleeves would be expected to inhibit bacterial colonization on external fixation pins and wires. This inhibition of bacterial colonization should substantially reduce the incidence of pin tract infection, and improve the overall outcome and cost effectiveness of external fixation fracture management.

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Economic Evaluation of 2 Treatments for Pediatric Femoral Shaft Fractures

Cited by 37 publications

References 18 publications

Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment

Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment

Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children

Bactericidal activity of antimicrobial coated polyurethane sleeves for external fixation pins

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