title: Damage control orthopaedics: Variability of construct design for external fixation of the lower extremity and implications on cost.
abstract: BACKGROUND
  To evaluate relative cost of external fixator constructs applied for damage control purposes in a cohort of advanced orthopaedic trainees and orthopaedic staff traumatologists. We also sought to evaluate physicians' understanding of component cost.
  
  
  METHODS
  Participants were asked to apply an external fixator for three separate fracture patterns in damage control fashion. A total of 19 physicians (nine PGY-4 residents, five PGY-5 residents, two orthopaedic trauma fellows and three orthopaedic staff traumatologists) participated. Total construct cost was calculated. Participants provided an estimate of the cost of each component in a fill-in format survey. Main outcome measures included cost of external fixator construct applied and the estimated cost of external fixator components.
  
  
  RESULTS
  Average whole sale cost of an external fixator construct was $5252 (±$1798). Of the three fracture types examined, the tibial plafond fracture external fixator construct on average cost the most, followed by the tibial plateau fracture and the femur fracture construct. The large ex-fix combination clamp was the major contributor to cost for each construct. The combination clamp may be substituted for a multi-pin clamp, resulting in significant cost savings. The self-drilling Schanz pin and the large ex-fix combination clamp were most highly underestimated (25% and 22% of their actual cost, respectively).
  
  
  CONCLUSIONS
  Innumerous construct designs exist and even small changes can significantly impact cost. Knowledge of component cost is low among staff and trainees. Education of component cost is vital to allow adequate consideration of construct design prior to fixator application.
authors.affiliation: Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02115, USA. Electronic address: calogan@partners.org.
authors.forename: Catherine
authors.initials: C
authors.lastname: Logan
authors.affiliation: Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02115, USA. Electronic address: ahess@partners.org.
authors.forename: Arthur
authors.initials: A
authors.lastname: Hess
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: jykwon@bidmc.harvard.edu.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kwon
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004503:Education, Medical, Graduate; D016267:External Fixators / Q000191:economics*; D005264:Femoral Fractures / Q000601:surgery*; D005592:Fracture Fixation / Q000191:economics* / Q000295:instrumentation; D006801:Humans; D009985:Orthopedics / Q000191:economics / Q000193:education*; D013978:Tibial Fractures / Q000601:surgery*
keywords: Cost; Damage control orthopaedics; External fixator; Trauma