title: Skeletal traction versus external fixation for pediatric femoral shaft fractures: a comparison of hospital costs and charges.
abstract: OBJECTIVE
  To compare the hospital costs, charges, and reimbursement for treatment of pediatric femur fractures by two treatment methods: external fixation and 90-90 traction with spica casting.
  
  
  METHODS
  Retrospective clinical review.
  
  
  METHODS
  Department of Orthopaedic Surgery, Children's Hospital Oakland, regional pediatric trauma center.
  
  
  METHODS
  Twenty-nine consecutive patients between the ages of five and ten with a fracture of the femoral shaft were treated by one of two methods: external fixation (sixteen patients) or 90-90 skeletal traction followed by spica casting (thirteen patients).
  
  
  METHODS
  External fixation or 90-90 traction followed by spica casting.
  
  
  METHODS
  Hospital billing data including costs, charges, reimbursement for the initial inpatient hospitalization, and outpatient financial data until fracture union and cessation of treatment.
  
  
  RESULTS
  There was no difference in age, total treatment time, mechanism of injury, or number of associated injuries between the two groups. The average charge for treatment with skeletal traction and spica casting was $32,094 per patient versus $21,439 for external fixation (p < 0.001). The average cost for treatment with traction and spica casting was $22,396 per patient versus $11,520 for external fixation (p < 0.001); reimbursement was $30,846 and $7,490, respectively (p < 0.001). The number of days in the hospital was larger for the traction group than for the external fixation group (22.3 days versus 4.7 days, p < 0.0001).
  
  
  CONCLUSIONS
  External fixation of pediatric femoral shaft fractures results in decreased hospital costs and length of hospitalization, but produces significantly less income for the hospital when compared with skeletal traction followed by spica casting.
authors.affiliation: Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA 98104-2499, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Nork
authors.forename: S A
authors.initials: SA
authors.lastname: Hoffinger
mesh_terms: D002140:California; D002648:Child; D016267:External Fixators; D005264:Femoral Fractures / Q000191:economics* / Q000601:surgery*; D005592:Fracture Fixation / Q000191:economics*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D009985:Orthopedics / Q000191:economics; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000191:economics; D014143:Traction / Q000191:economics*; D016896:Treatment Outcome