Uniplanar Versus Taylor Spatial Frame External Fixation For Pediatric Diaphyseal Tibia Fractures: A Comparison of Cost and Complications. Issue 8 (December 2016)

• Record Type: Journal Article
• Authors: Shore, Benjamin J.; DiMauro, Jon-Paul P.; Spence, David D.; Miller, Patricia E.; Glotzbecker, Michael P.; Spencer, Samantha; Hedequist, Daniel
• Is Part Of: Journal of pediatric orthopaedics. Volume 36:Issue 8(2016)
• Publication Date: 2016-12
• Subjects: Taylor Spatial Frame -- external fixation -- tibial shaft fracture -- cost analysis; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000000561
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: The purpose of this study was to compare the outcomes and cost variations between uniplanar (UNI) and Taylor Spatial Frame (TSF) external fixation for unstable pediatric tibial diaphyseal fractures. Methods: We performed an IRB approved, retrospective review of 44 diaphyseal tibial fractures in 42 children treated with external fixation (16 TSF and 28 UNI) between 2003 and 2011, at a single level 1 pediatric trauma center. Data on demographic, clinical, radiographic, treatment cost, and complication differences were analyzed between the 2 groups. The Student t tests, Fisher's exact tests, χ 2 trend tests, logistic regression, and a cost analysis comparison was used to assess the differences. Results: The mean age in both groups was 13 years (range: 6 to 18 y TSF, 9 to 17 y UNI). The mean follow-up was 8 months (TSF) and 13 months (UNI). According to the AO classification, there were 28 type A, 13 type B, and 3 type C fractures with no significant difference between the 2 groups ( P =0.69). Total time in the fixator was not different between the 2 groups (UNI 14 wk, TSF 12 wk, P =0.10), but time to union was less in the TSF group (UNI 16 wk, TSF 13 wk, P <0.01). There were no differences in the final radiographic alignment between the groups. The UNI group experienced more complications (7 pin-site infections and 9 reoperations) compared with 4 pin-site infections and 2 reoperations in the TSF group. A cost analysis revealed significant differences in equipment cost (UNI frame=$5074 vs. TSF frame=$10, 675; P <0.0001); however, after corrected cost analysis with calculated return to the operating room for complications, there was no difference in cost of treatment (UNI treatment=$20, 113 vs. TSF treatment=$19, 138). Conclusions: Despite an initial equipment cost difference between UNI and TSF frames, corrected cost analysis reveals equivalent costs for care delivery. Therefore, TSF can be considered as a cost-conscious device for the treatment of unstable pediatric tibial diaphyseal fractures. Level of Evidence: Level III—retrospective comparative cohort study.