Abstract
Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.
Highlights
Forearm fractures are the most common fractures in childhood [1]
Closed reduction and cast was used in 46 patients, closed or open reduction and K wire(s) was used in 82 patients, and closed or open reduction and Titanium Elastic Nail (TEN) was used in 44 patients
Postoperative cast was used in all of the patients treated with K-wires, in 5 patients treated with 1 TEN, and none of the patients treated with 2 TEN
Summary
There are various methods of management of forearm fractures in children: Closed reduction and plaster cast, closed/open reduction, and intramedullary K wire stabilization. Elastic intramedullary nails were introduced for the first time in the late 1970s, and since the technique has changed very little [2] It was used for children for whom cast treatment was not a viable solution but had soon been adopted for all diaphysis fractures. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire
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