Uniplanar Versus Taylor Spatial Frame External Fixation For Pediatric Diaphyseal Tibia Fractures: A Comparison of
Benjamin J Shore1, Jon-Paul P DiMauro, David D Spence
1*Boston Children's Hospital Department of Orthopedic Surgery, Harvard Medical School, Boston, MA †Hofstra North Shore, LIJ School of Medicine, Hempstead, NY ‡Campbell Clinic Orthopaedics, LeBonheur Children's Hospital, Memphis, TN.
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 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.
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