Economic Evaluation of Reamed versus Unreamed Intramedullary Nailing in Patients with Closed and Open Tibial Fractures: Results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)

Briel, Matthias; Sprague, Sheila; Heels‐Ansdell, Diane; Guyatt, Gordon; Bhandari, Mohit; Blackhouse, Gordon; Sanders, David; Schemitsch, Emil H.; Swiontkowski, Marc F.; Tornetta, Paul; Walter, Stephen D.; Goeree, Ron

doi:10.1016/j.jval.2010.10.034

Cited by 20 publications

(15 citation statements)

References 10 publications

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“…One study showed that there was no significant difference in the costs from the index procedure, index hospital stay, and fracture-associated medications; however, the re-operation costs were quite different between reamed and unreamed intramedullary nailing [1]. Our study showed that the re-operation rate was similar in the two treatment groups.…”

Section: Discussionmentioning

confidence: 45%

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Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

et al. 2014

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BackgroundOpen fractures of the tibial diaphysis are usually caused by high-energy trauma and associated with severe bone and soft tissue injury. Reamed and unreamed intramedullary nailing are often used for treatment of tibial injury. The purpose of this study was to investigate the clinical efficacy of reamed versus unreamed intramedullary nailing for open tibial fractures (OTF).MethodsA meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using databases containing the Cochrane Library, PubMed, EMbase, Chinese Biomedical Database, Chinese VIP information, and WanFang Database. Randomized and semi-randomized controlled clinical trials of both reamed and unreamed intramedullary nailing for OTF treatment were analyzed using Reviewer Manager (RevMan5.0) software.ResultsA total of 695 references were initially identified from the selected databases. However, only four studies were assessed, matching all the eligibility criteria conducted by two independent reviewers. The result showed that there was no statistical difference in healing rate, secondary surgery rate, implant failure rate, osteofascial compartment syndrome, and infection during the postoperative period between reamed and unreamed nails in OTF.ConclusionsFindings of this study suggest that there was no statistical difference between reamed and unreamed intramedullary nailing in clinical treatment of OTF. However, the result of this meta-analysis should be cautiously accepted due to some limitations, and further studies are still needed.

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Section: Discussionmentioning

confidence: 45%

“…They can be classified into open and closed tibial fractures according to soft tissue injuries [1]. Open tibial fractures (OTF) are often associated with severe bone and soft tissue injury [2].…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

et al. 2014

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“…The extent and condition of soft tissue is a prerequisite for any management options [16,17]. Intramedullary nail is considered the optimal management choice in most case scenario [6,13,18,19], it is capable of providing early weight bearing and lower incidence of malalignment with less interference in the soft tissue of fracture site. Currently the indications for the IMN use is extending for distal tibial fractures with the improvement of nail design and application of a variety of the reduction techniques presented to minimize the malalignment such as poller screws and plateassistant reduction.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

Xu¹,

Ren²,

Zhong³

et al. 2020

Preprint

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Background To analyze the clinical characteristic and economic of intramedullary nailing versus locking compression plate for the treatment of open distal tibial fractures.Methods A retrospective analysis was conducted by enrolling patients with open distal tibial fractures who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department，Xi’an Honghui Hospital from January 2016 to January 2019. The collected clinical materials and data included gender, age, injury mechanism, smoke and alcohol, comorbidity disease, Gustilo classification, days before operation, final treatment option, surgical duration, intraoperative bleeding loss, length of stay, complications, Johner-Wruhs criteria, total cost within 1 year after surgery (including hospitalization expenses and postoperative rehabilitation or follow-up expenses). All the patients were divided into two groups based on the final treatment options: Group IMN(intramedullary nailing) and Group LCP(locking compression plate). Cost data for each case within 1 year after surgery were analyzed for the cost-effectiveness ratio (CER)and incremental cost-effectiveness ratio (ICER) of IMN versus LCP.Results 49 consecutive cases were enrolled including 28 cases of Group IMN and 21 cases of Group LCP with the excellent and good rate of 82.1% (23 cases) and 85.7% (18 cases) respectively based on Johner-Wruhs criteria. The surgical duration (p=0.017) and intraoperative bleeding loss(p=0.046) were significantly lower in Group IMN than in Group LCP. Total cost within 1 year after surgery(p=0.048) was also less in Group IMN（126435.90±39093.98 CNY）than in Group LCP（147834.60±56821.12 CNY）. No statistically significant difference was discovered on the excellent and good rate of Johner-Wruhs criteria between the two groups(p＞0.05). The average cost for every 1% of excellent and good rate was 1540.02 CNY in Group IMN and 1725.02 CNY in Group LCP. Each 1% increasing of excellent and good rate cost 5944.08 CNY more in Group LCP compared with Group IMN.Conclusions Both the IMN and LCP could provide a satisfactory outcome for open distal tibial fractures. However the IMN was a more cost-effective management than LCP when the economic analysis was included.

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“…Injuries occurring here are classified based on soft tissue injury as open or closed. 1 Open tibial fractures are often associated with severe soft tissue and bone injury. 2 The management of open fractures is regarded as an orthopaedic emergency.…”

Section: Introductionmentioning

confidence: 99%

Recapitulation of primary nailing in open diaphyseal fractures of tibia

et al. 2019

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Tibia fractures are the commonest long bone fracture, most commonly resulting from high velocity injury. We investigated whether primary nailing in open tibia fractures were producing satisfactory outcomes and we compared the outcomes in terms of fracture union and rates of infection. We identified 202 citations related to our searches from our key words, out of which 89 were original articles, which were eligible and others were case reports and review articles. We found 4 from these references which had the parallel inclusion criteria and were reviewed. All 4 studies had almost similar time period for the fracture union. Infection rates in this study were directly related to the severity of the grade of injury, which were commonly experienced in grade III injuries. In conclusion, our analysis had no significant difference in postoperative healing duration, implant failure rates, postoperative infection and secondary operation rates in primary nailing for open tibia fractures.

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Economic Evaluation of Reamed versus Unreamed Intramedullary Nailing in Patients with Closed and Open Tibial Fractures: Results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)

Abstract: Our economic analysis from a governmental perspective suggests small differences in both cost and effectiveness with large uncertainty between reamed and unreamed intramedullary nailing.

Cited by 20 publications

References 10 publications

Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

Recapitulation of primary nailing in open diaphyseal fractures of tibia

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