Reuse of external skeletal fixator components: effects on costs and complications

Although many community hospitals and trauma centers reuse external fixator components, no published studies have examined the cost-effectiveness or the effect on the rate of complications of reuse. This study reports the preliminary results of a program for the reuse of selected components of external fixators at a trauma center.

After removal from the patient, fixators were cleaned and examined by a single nurse responsible for the program. Components in good repair were returned to the operating room stock for reuse, whereas those showing specific signs of wear were discarded. No component was used more than three times. The medical center charged patients a loaner fee equal to the hospital's cost for reusable components of external fixators. Data were collected for all fixators applied in the 15 months before and after institution of the program (69 and 65 fixators, respectively).

The overall mean hospital charge for a fixator decreased 32% as a result of the reuse program (from $4,067 to $2,791). For the two fractures most commonly treated with external fixation, the distal radius and tibial plafond fractures, the mean charge decreased 44 and 29%, respectively. The mean hospital cost for a fixator decreased 34% as a result of the program (from $1,864 to $1,238). There were no differences in the rates of reoperation or complications before and after institution of the reuse program. No patient had mechanical failure of a new or reused fixator body.

The preliminary results of this program are encouraging. We recommend that institutions reusing these devices develop specific programs outlining criteria for reuse and guidelines for reprocessing devices for reuse. The results of this study represent an important first step in the validation of the efficacy and safety of reuse of external fixator components.