title: Uniplanar Versus Taylor Spatial Frame External Fixation For Pediatric Diaphyseal Tibia Fractures: A Comparison of Cost and Complications.
abstract: BACKGROUND
  The purpose of this study was to compare the outcomes and cost variations between uniplanar (UNI) and Taylor Spatial Frame (TSF) external fixation for unstable pediatric tibial diaphyseal fractures.
  
  
  METHODS
  We performed an IRB approved, retrospective review of 44 diaphyseal tibial fractures in 42 children treated with external fixation (16 TSF and 28 UNI) between 2003 and 2011, at a single level 1 pediatric trauma center. Data on demographic, clinical, radiographic, treatment cost, and complication differences were analyzed between the 2 groups. The Student t tests, Fisher's exact tests, χ trend tests, logistic regression, and a cost analysis comparison was used to assess the differences.
  
  
  RESULTS
  The mean age in both groups was 13 years (range: 6 to 18 y TSF, 9 to 17 y UNI). The mean follow-up was 8 months (TSF) and 13 months (UNI). According to the AO classification, there were 28 type A, 13 type B, and 3 type C fractures with no significant difference between the 2 groups (P=0.69). Total time in the fixator was not different between the 2 groups (UNI 14 wk, TSF 12 wk, P=0.10), but time to union was less in the TSF group (UNI 16 wk, TSF 13 wk, P<0.01). There were no differences in the final radiographic alignment between the groups. The UNI group experienced more complications (7 pin-site infections and 9 reoperations) compared with 4 pin-site infections and 2 reoperations in the TSF group. A cost analysis revealed significant differences in equipment cost (UNI frame=$5074 vs. TSF frame=$10,675; P<0.0001); however, after corrected cost analysis with calculated return to the operating room for complications, there was no difference in cost of treatment (UNI treatment=$20,113 vs. TSF treatment=$19,138).
  
  
  CONCLUSIONS
  Despite an initial equipment cost difference between UNI and TSF frames, corrected cost analysis reveals equivalent costs for care delivery. Therefore, TSF can be considered as a cost-conscious device for the treatment of unstable pediatric tibial diaphyseal fractures.
  
  
  METHODS
  Level III-retrospective comparative cohort study.
authors.affiliation: *Boston Children's Hospital Department of Orthopedic Surgery, Harvard Medical School, Boston, MA †Hofstra North Shore, LIJ School of Medicine, Hempstead, NY ‡Campbell Clinic Orthopaedics, LeBonheur Children's Hospital, Memphis, TN.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Shore
authors.forename: Jon-Paul P
authors.initials: JP
authors.lastname: DiMauro
authors.forename: David D
authors.initials: DD
authors.lastname: Spence
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Miller
authors.forename: Michael P
authors.initials: MP
authors.lastname: Glotzbecker
authors.forename: Samantha
authors.initials: S
authors.lastname: Spencer
authors.forename: Daniel
authors.initials: D
authors.lastname: Hedequist
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D013977:Tibia / Q000293:injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome