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Surgical management for displaced pediatric proximal humeral fractures: a cost analysis
Benjamin J Shore1, Daniel J Hedequist, Patricia E Miller
1Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Hunnewell 221, 300 Longwood Avenue, Boston, MA, 02115, USA, Benjamin.shore@childrens.harvard.edu.
Insights
For pediatric proximal humeral fractures, exposing percutaneous pins is more cost-effective than burying them or using intramedullary nails. This method offers significant cost savings in surgical fixation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Health economics
Background:
- Displaced pediatric proximal humeral fractures (PPHF) require effective surgical stabilization.
- Comparing cost-effectiveness of different fixation methods is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To determine the most cost-effective surgical fixation method for displaced pediatric proximal humeral fractures (PPHF).
- To compare percutaneous pinning (PP) with intramedullary nailing (IMN) in terms of cost-effectiveness.
Main Methods:
- Retrospective cohort study of surgically treated PPHF over 12 years.
- Decision analysis model comparing three strategies: IMN, percutaneous pinning with exposed pins (PPE), and percutaneous pinning with buried pins (PPB).
- Sensitivity analyses were conducted varying infection rates and costs.
Main Results:
- 84 patients with displaced PPHF were analyzed.
- The percutaneous pinning with exposed pins (PPE) technique demonstrated an average cost saving of $4,502 per patient versus IMN and $2,066 versus PPB.
- PPE remained cost-effective even with complication rates up to 55%.
Conclusions:
- Exposing pins after surgical fixation of PPHF is more cost-effective than burying pins or using intramedullary fixation.
- The PPE technique offers a superior economic profile for treating these fractures.
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.
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