title: Operative Cost Comparison: Plating Versus Intramedullary Fixation for Clavicle Fractures.
abstract: Although clavicle fractures often heal well with nonoperative management, current literature has shown improved outcomes with operative intervention for specific fracture patterns in specific patient types. The 2 most common methods of midshaft clavicle fracture fixation are intramedullary and plate devices. Through retrospective analysis, this study performed a direct cost comparison of these 2 types of fixation at a single institution over a 5-year period. Outcome measures included operative costs for initial surgery and any hardware removal surgeries. This study reviewed 154 patients (157 fractures), and of these, 99 had intramedullary fixation and 58 had plate fixation. A total of 80% (79 of 99) of intramedullary devices and 3% (2 of 58) of plates were removed. Average cost for initial intramedullary placement was $2955 (US dollars) less than that for initial plate placement (P<.001); average cost for removal was $1874 less than that for plate removal surgery (P=.2). Average total cost for all intramedullary surgeries was $1392 less than the average cost for all plating surgeries (P<.001). Average cost for all intramedullary surgeries requiring plate placement and removal was $653 less than the average cost for all plating surgeries that involved only placement (P=.04). Intramedullary fixation of clavicle fractures resulted in a statistically significant cost reduction compared with plate fixation, despite the incidence of more frequent removal surgeries. [Orthopedics.2016; 39(5):e877-e882.].
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Hanselman
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Murphy
authors.forename: George K
authors.initials: GK
authors.lastname: Bal
authors.forename: E Barry
authors.initials: EB
authors.lastname: McDonough
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000191:economics*; D002968:Clavicle / Q000293:injuries*; D003365:Costs and Cost Analysis; D005260:Female; D005592:Fracture Fixation / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000191:economics* / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000191:economics / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies