Comparison of direct and indirect costs of internal fixation and cast treatment in acute scaphoid fractures: a randomized trial involving 52 patients.
BACKGROUND
The most cost-effective treatment of scaphoid fractures has not yet been determined.


METHODS
In a prospective trial, 52 employed or selfemployed patients with scaphoid fractures were randomized to closed (cast) or surgical treatment.


RESULTS
There were 3 complications in the surgical group and 1 in the cast group. Median time off work was numerically but not statistically significantly greater after cast than after surgery (74/39 days). Manual workers (manuals) had a longer time away from work than non-manual employees/individuals who were selfemployed (non-manuals; median 84 days and 16 days, respectively; p < 0.001) and they had a longer time off work after cast than after surgery (median 100 days and 61 days; p = 0.03). Hospital costs were lower after cast than after surgery (p < 0.001). Work disability costs were numerically but not statistically significantly higher after cast than after surgery, and similarly, the total costs were lower after cast than after surgery. Work disability costs and total costs were higher in manuals than in non-manuals (p < 0.001). Non-manuals had lower total costs after cast than after surgery (p = 0.05).


CONCLUSIONS
There was a longer period of absence from work after cast than after surgery in manuals, but not in non-manuals. In non-manuals, total costs were lower after cast than after surgery. Socioeconomic classification had a greater influence on cost than mode of treatment.
Vinnars
Bertil
B
Center for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden. bertil.vinnars@akademiska.se
Ekenstam
Fredrik Af
FA
Gerdin
Bengt
B
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical / Q000009:adverse effects / Q000191:economics*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000191:economics*; D017102:Fracture Healing; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009790:Occupations; D011446:Prospective Studies; D021361:Scaphoid Bone / Q000293:injuries*; D018582:Sick Leave / Q000191:economics; D012959:Socioeconomic Factors