Volar locking plates versus Kirschner wires for distal radial fractures--a cost analysis study

There is an increasing trend for managing dorsally angulated distal radial fractures with locked volar plate fixation in fractures that may have previously been managed with percutaneous Kirschner wire (K-wire) fixation. There has been no prospective randomised trial comparing locked volar plate fixation with percutaneous K-wire fixation. In the absence of data guiding management with regard to clinical effectiveness, we have examined the cost of each technique.

Patients' details were collected retrospectively between June 2007 and June 2008. Ten consecutive patients who underwent percutaneous K-wire fixation for a distal radius fracture and the 10 who were treated by locked volar plate fixation were identified and their hospital notes retrieved. All patients had a closed extra-articular distal radial fracture with dorsal angulation. The duration and type of operation, including number of wires or screws used, were recorded.

The mean age of the patients was 54 years for the locking plate group and 34 years for the percutaneous K-wire group. The mean time taken to perform percutaneous K-wire fixation with an average of two K-wires was 56 min. The mean time for applying a volar locked plate was 121 min. The cost of a pack of 10 K-wires was 3 pounds. The total cost of a standard volar locking plate and screws used was 787 pounds.

In the absence of research comparing clinical end points, cost must play a major factor in determining the type of operation offered. A 56-min operation to percutaneously fix a distal radial fracture with K-wires costs 662 pounds. This compares to a cost of 2212 pounds for a 121-min locked volar plate fixation. There is a calculated difference of 1549 pounds and 65 min.

With use of a locked volar plate for patients under the age of 70 years there is a loss of 652 pounds for the Trust with the present NHS tariffs.