Economic considerations on avoiding implant removals after fracture fixation by using absorbable devices

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Health economics

Background:

• Absorbable polymer implants for internal fracture fixation have been available since the late 1980s.
• These devices eliminate the need for secondary surgery to remove implants.
• Common applications include malleolar ankle and radial head fractures.

Purpose of the Study:

• To conduct a cost analysis comparing absorbable polymer implants with traditional metallic fixation devices.
• To determine the economic break-even points for absorbable implants based on metallic implant removal frequency.

Main Methods:

• A retrospective analysis of 1219 patients treated between 1985-1991 with absorbable fixation devices.
• Economic evaluation comparing total costs of absorbable fixation versus metallic fixation, including potential removal costs.

Main Results:

• High initial costs of absorbable implants can offset savings from avoiding removal procedures.
• In trimalleolar fractures, absorbable implants saved FIM 2023 per patient when removal was considered.
• If metallic implants are not removed, metallic devices are more economical by FIM 3684 per patient.

Conclusions:

• The economic advantage of absorbable vs. metallic implants is directly proportional to the rate of metallic implant removal.
• Break-even points for absorbable implants range from 30% (radial head) to 65% (trimalleolar ankle fractures).
• Absorbable devices are financially favorable only when metallic implant removal rates exceed these calculated break-even points.