An economic analysis of management strategies for closed and open grade I tibial shaft fractures.
BACKGROUND
Closed and open grade I (low-energy) tibial shaft fractures are a common and costly event, and the optimal management for such injuries remains uncertain.


METHODS
We explored costs associated with treatment of low-energy tibial fractures with either casting, casting with therapeutic ultrasound, or intramedullary nailing (with and without reaming) by use of a decision tree.


RESULTS
From a governmental perspective, the mean associated costs were USD 3,400 for operative management by reamed intramedullary nailing, USD 5,000 for operative management by non-reamed intramedullary nailing, USD 5,000 for casting, and USD 5,300 for casting with therapeutic ultrasound. With respect to the financial burden to society, the mean associated costs were USD 12,500 for reamed intramedullary nailing, USD 13,300 for casting with therapeutic ultrasound, USD 15,600 for operative management by non-reamed intramedullary nailing, and USD 17,300 for casting alone.


CONCLUSIONS
Our analysis suggests that, from an economic standpoint, reamed intramedullary nailing is the treatment of choice for closed and open grade I tibial shaft fractures. Considering financial burden to society, there is preliminary evidence that treatment of low-energy tibial fractures with therapeutic ultrasound and casting may also be an economically sound intervention.
Busse
Jason W
JW
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. j.busse@utoronto.ca
Bhandari
Mohit
M
Sprague
Sheila
S
Johnson-Masotti
Ana P
AP
Gafni
Amiram
A
D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005592:Fracture Fixation / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D009864:Ontario; D011183:Postoperative Complications / Q000191:economics; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery; D014463:Ultrasonography