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

DSpace/Manakin Repository

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

Citable link to this page

 

 
Title: Surgical management for displaced pediatric proximal humeral fractures: a cost analysis
Author: Shore, Benjamin J.; Hedequist, Daniel J.; Miller, Patricia E.; Waters, Peter M.; Bae, Donald S.

Note: Order does not necessarily reflect citation order of authors.

Citation: Shore, Benjamin J., Daniel J. Hedequist, Patricia E. Miller, Peter M. Waters, and Donald S. Bae. 2015. “Surgical management for displaced pediatric proximal humeral fractures: a cost analysis.” Journal of Children's Orthopaedics 9 (1): 55-64. doi:10.1007/s11832-015-0643-2. http://dx.doi.org/10.1007/s11832-015-0643-2.
Full Text & Related Files:
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.
Published Version: doi:10.1007/s11832-015-0643-2
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340855/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:14065336
Downloads of this work:

Show full Dublin Core record

This item appears in the following Collection(s)

 
 

Search DASH


Advanced Search
 
 

Submitters