Surgical management for displaced pediatric proximal humeral fractures: A cost analysis. (February 2015)

• Record Type: Journal Article
• Authors: Shore, Benjamin J.; Hedequist, Daniel J.; Miller, Patricia E.; Waters, Peter M.; Bae, Donald S.
• Is Part Of: Journal of children's orthopaedics. Volume 9:Number 1(2015)
• Page Start: 55
• Page End: 64
• Publication Date: 2015-02
• Subjects: Pediatric proximal humerus fractures -- Decision analysis -- Cost analysis; Pediatric orthopedics -- Periodicals; 618.927005
• DOI: 10.1007/s11832-015-0643-2
• Languages: English
• ISSNs: 1863-2521

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.