Identifying Drivers of Implant Cost Variation in Distal Radius Fracture Open Reduction and Internal Fixation

Volar locking plates are widely used for open reduction and internal fixation (ORIF) of distal radius fractures; however, variation exists in implant selection, construct complexity, and overall cost.

Patients who underwent ORIF with a volar locking plate for distal radius fractures between January 2023 and December 2024 were identified using current procedural terminology codes 25607, 25608, and 25609. Demographic and clinical variables were extracted from the electronic health record. Implant, supply, and total material costs were obtained from cost reports, and screw counts were verified on radiographs. Bivariate analyses of costs and explanatory variables were performed using Student's t test, Mann-Whitney U test, or chi-squared tests.

In a cohort of 496 patients, median age was 63 years and 81.9% were women. The median implant cost was $1,641 (interquartile range: $1,417 to $1,944), and the median total material cost was $1,830 (interquartile range: $1,633 to $2,264). A mean of 8.7 ± 1.4 screws were used per case. Both implant costs and total costs were significantly associated with implant manufacturer, total screw count, bone allograft use, fracture type, and operating time (all P < .05). Costs were not associated with age, sex, body mass index, race, diabetes, smoking status, dominant hand fracture, open fracture, surgeon subspeciality, or surgical assistant type (P > .05).

Implant costs for distal radius ORIF are largely influenced by variables related to fracture complexity, such as screw count, bone allograft use (and usage), and operation time, as well as system-level variables, such as implant manufacturer.