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An economic analysis of management strategies for closed and open grade I tibial shaft fractures.

https://arctichealth.org/en/permalink/ahliterature172175
Source
Acta Orthop. 2005 Oct;76(5):705-12
Publication Type
Article
Date
Oct-2005
Author
Jason W Busse
Mohit Bhandari
Sheila Sprague
Ana P Johnson-Masotti
Amiram Gafni
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. j.busse@utoronto.ca
Source
Acta Orthop. 2005 Oct;76(5):705-12
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Cost of Illness
Costs and Cost Analysis
Fracture Fixation - adverse effects - economics - methods
Fracture Fixation, Internal - adverse effects - economics - methods
Fracture Fixation, Intramedullary - adverse effects - economics - methods
Fractures, Closed - economics - surgery - ultrasonography
Fractures, Open - economics - surgery - ultrasonography
Health Care Costs
Humans
Length of Stay - economics
Ontario
Postoperative Complications - economics
Tibial Fractures - economics - surgery - ultrasonography
Abstract
Closed and open grade I (low-energy) tibial shaft fractures are a common and costly event, and the optimal management for such injuries remains uncertain.
We explored costs associated with treatment of low-energy tibial fractures with either casting, casting with therapeutic ultrasound, or intramedullary nailing (with and without reaming) by use of a decision tree.
From a governmental perspective, the mean associated costs were USD 3,400 for operative management by reamed intramedullary nailing, USD 5,000 for operative management by non-reamed intramedullary nailing, USD 5,000 for casting, and USD 5,300 for casting with therapeutic ultrasound. With respect to the financial burden to society, the mean associated costs were USD 12,500 for reamed intramedullary nailing, USD 13,300 for casting with therapeutic ultrasound, USD 15,600 for operative management by non-reamed intramedullary nailing, and USD 17,300 for casting alone.
Our analysis suggests that, from an economic standpoint, reamed intramedullary nailing is the treatment of choice for closed and open grade I tibial shaft fractures. Considering financial burden to society, there is preliminary evidence that treatment of low-energy tibial fractures with therapeutic ultrasound and casting may also be an economically sound intervention.
PubMed ID
16263619 View in PubMed
Less detail

Cast treatment and intramedullary locking nailing for simple and spiral wedge tibial shaft fractures--a cost benefit analysis.

https://arctichealth.org/en/permalink/ahliterature197823
Source
Ann Chir Gynaecol. 2000;89(2):138-42
Publication Type
Article
Date
2000
Author
J A Toivanen
M. Hirvonen
O. Auvinen
S E Honkonen
T L Järvinen
A M Koivisto
M J Järvinen
Author Affiliation
Section of Orthopaedics and Traumatology, Department of Surgery, Tampere University Hospital, Finland. lljato@uta.fi
Source
Ann Chir Gynaecol. 2000;89(2):138-42
Date
2000
Language
English
Publication Type
Article
Keywords
Adult
Bone Nails
Casts, Surgical - economics
Cost-Benefit Analysis
Female
Finland
Fracture Fixation, Intramedullary - economics
Humans
Male
Middle Aged
Retrospective Studies
Tibial Fractures - surgery
Abstract
The aim of this retrospective study was to compare the relative costs of treating simple and spiral wedge (requiring closed reduction under anaesthesia) tibial shaft fractures in a plaster cast or with intramedullary locking nail.
The material consisted of 26 fractures treated in a plaster cast and 51 fractures treated with an intramedullary locking nail. The costs caused by the direct costs (treatment, hospitalisation, and outpatient appointments) as well as indirect costs (lost productivity) were taken into account. Costs caused by complications were also included in the analysis.
Mean direct costs per patient were FIM 22920 and FIM 26952 and mean overall costs per patient were FIM 120486 and FIM 82224 in plaster cast and intramedullary locking nailing groups, respectively (FIM 1 = USD 0.19). The higher mean overall costs of the plaster cast group were attributable to the longer sick leave periods in this group (218 days in plaster cast group and 124 in intramedullary nailing group).
Plaster cast treatment of simple and spiral wedge tibial shaft fractures requiring closed reduction under anaesthesia is more expensive to society than operative treatment with intramedullary locking nail.
PubMed ID
10905681 View in PubMed
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The changing pattern of pediatric both-bone forearm shaft fractures among 86,000 children from 1997 to 2009.

https://arctichealth.org/en/permalink/ahliterature116006
Source
Eur J Pediatr Surg. 2013 Aug;23(4):289-96
Publication Type
Article
Date
Aug-2013
Author
Juha-Jaakko Sinikumpu
Tytti Pokka
Willy Serlo
Author Affiliation
Clinic of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland. juha-jaakko.sinikumpu@ppshp.fi
Source
Eur J Pediatr Surg. 2013 Aug;23(4):289-96
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Female
Finland - epidemiology
Follow-Up Studies
Forearm Injuries - surgery
Fracture Fixation, Intramedullary - methods
Humans
Incidence
Infant
Infant, Newborn
Male
Radius Fractures - epidemiology - surgery
Reoperation
Risk factors
Treatment Outcome
Ulna Fractures - epidemiology - surgery
Abstract
Forearm fractures are common among children. Unlike most pediatric fractures, there is a risk of unsatisfactory results in forearm shaft fractures. The healing of a tubular bone is most unlikely in the diaphysis far away from the metaphyseal zones. The treatment of forearm shaft fractures is evolving. The purpose of the study was to analyze the pattern of forearm shaft fractures and their treatment in a population of children in recent years.
All the children (from 0 to 16 years) with a both-bone forearm shaft fracture (AO-segment 22-D) during the years 1997 to 2009 in a catchment area of about 86,000 children were included in this population-based study. There were 291 fractures in all. The age-related annual incidences, background factors, seasonal variation, injury types, treatment, reoperations, and short-term outcome were determined.
The incidence of all forearm shaft fractures increased threefold in 1997 to 2009 (p
PubMed ID
23444075 View in PubMed
Less detail

Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons.

https://arctichealth.org/en/permalink/ahliterature154854
Source
Acta Orthop. 2008 Oct;79(5):689-94
Publication Type
Article
Date
Oct-2008
Author
Jason W Busse
Emily Morton
Christina Lacchetti
Gordon H Guyatt
Mohit Bhandari
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. j.busse@utoronto.ca
Source
Acta Orthop. 2008 Oct;79(5):689-94
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Canada
Clinical Competence
Cross-Sectional Studies
Electric Stimulation Therapy
Female
Fracture Fixation, Internal - methods
Fracture Fixation, Intramedullary - methods
Fracture Healing - drug effects - physiology
Humans
Male
Physician's Practice Patterns
Questionnaires
Tibial Fractures - surgery
Ultrasonic Therapy
Abstract
Strategies to manage tibial fractures include nonoperative and operative approaches. Strategies to enhance healing include a variety of bone stimulators. It is not known what forms of management for tibial fractures predominate among Canadian orthopedic surgeons. We therefore asked a representative sample of orthopedic trauma surgeons about their management of tibial fracture patients.
This was a cross-sectional survey of 450 Canadian orthopedic trauma surgeons. We inquired about demographic variables and current tibial shaft fracture management strategies.
268 surgeons completed the survey, a response rate of 60%. Most respondents (80%) managed closed tibial shaft fracture operatively; 47% preferred reamed intramedullary nailing and 40% preferred unreamed. For open tibial shaft fractures, 59% of surgeons preferred reamed intramedullary nailing. Some surgeons (16%) reported use of bone stimulators for management of uncomplicated open and closed tibial shaft fractures, and almost half (45%) made use of this adjunctive modality for complicated tibial shaft fractures. Low-intensity pulsed ultrasound and electrical stimulation proved equally popular (21% each) and 80% of respondents felt that a reduction in healing time of 6 weeks or more, attributed to a bone stimulator, would be clinically important.
Current practice regarding orthopedic management of tibial shaft fractures in Canada strongly favors operative treatment with intramedullary nailing, although respondents were divided in their preference for reamed and unreamed nailing. Use of bone stimulators is common as an adjunctive modality in this injury population. Large randomized trials are needed to provide better evidence to guide clinical decision making regarding the choice of reamed or unreamed nailing for tibial shaft fractures, and to inform surgeons about the actual effect of bone stimulators.
PubMed ID
18839377 View in PubMed
Less detail

The effects of intraoperative positioning on patients undergoing early definitive care for femoral shaft fractures.

https://arctichealth.org/en/permalink/ahliterature147505
Source
J Orthop Trauma. 2009 Oct;23(9):615-21
Publication Type
Article
Date
Oct-2009
Author
K L Apostle
K A Lefaivre
P. Guy
H M Broekhuyse
P A Blachut
P J O'Brien
R N Meek
Author Affiliation
Department of Orthopaedics, University of British Columbia, 3114, 910West, 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada. kapostle@me.com
Source
J Orthop Trauma. 2009 Oct;23(9):615-21
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Bone Nails
British Columbia - epidemiology
Cohort Studies
Female
Femoral Fractures - mortality - physiopathology - surgery
Fracture Fixation, Intramedullary - instrumentation - methods
Humans
Intensive Care Units
Intraoperative Care
Intraoperative Period
Male
Middle Aged
Retrospective Studies
Supine Position
Survival Rate
Trauma Centers
Trauma Severity Indices
Young Adult
Abstract
To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position.
Retrospective cohort study, single centered.
One level 1 trauma center.
Nine hundred eighty-eight patients representing 1027 femoral shaft fractures treated with IM nails were identified through a prospectively gathered database between 1987 and 2006.
Antegrade IM nail insertion with reaming of the femoral canal in either the supine or lateral position.
Mortality was the primary outcome. Admission to intensive care unit (ICU) was the secondary outcome measure and a surrogate measure of morbidity. Literature review was performed to identify factors shown to contribute to morbidity and mortality in orthopaedic trauma patients. Intraoperative position in either the supine or lateral position was added to this list. Logistic regression analysis was performed to determine the magnitude and effect of the independent variables on each of the study end points. To determine if a more significant trend toward less favorable outcomes was observed with increasing severity of injury, particularly injuries of the chest and thorax, subgroup analysis was performed for all those with a femur fracture and an Injury Severity Score > or =18 and all those with a femur fracture and an Abbreviated Injury Score chest > or =3.
Intraoperative position in either the supine or lateral position was not a significant predictor of mortality or ICU admission for the original cohort or the subgroup of Injury Severity Score > or =18. However, for the subgroup of Abbreviated Injury Score chest > or =3, intraoperative positioning in the lateral position had a statistically significant protective effect against ICU admission (P = 0.044).
For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in the lateral position is not associated with an increased risk of mortality or ICU admission.
PubMed ID
19897981 View in PubMed
Less detail

Extra- and intramedullary implants for the treatment of pertrochanteric fractures -- results from a Finnish National Database Study of 14,915 patients.

https://arctichealth.org/en/permalink/ahliterature121302
Source
Injury. 2012 Dec;43(12):2156-60
Publication Type
Article
Date
Dec-2012
Author
Tero T Yli-Kyyny
Reijo Sund
Merja Juntunen
Jari J Salo
Heikki P J Kröger
Author Affiliation
Department of Orthopedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland. tero.yli-kyyny@kuh.fi
Source
Injury. 2012 Dec;43(12):2156-60
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Screws - statistics & numerical data
Databases, Factual
External Fixators
Female
Finland - epidemiology
Fracture Fixation, Internal - statistics & numerical data
Fracture Fixation, Intramedullary - statistics & numerical data
Hip Fractures - epidemiology - surgery
Humans
Male
Meta-Analysis as Topic
Randomized Controlled Trials as Topic
Registries
Abstract
We analysed registry-based data on 14,915 patients treated for pertrochanteric fracture obtained from the Finnish Health Care Register during the years 1999-2009. Data on the comorbidities, residential status and deaths of the cohort were extracted from several Finnish registries using patients' unique personal identification numbers. The use of intramedullary implants increased substantially during the study period. One-year mortality was slightly higher in the patients treated with intramedullary implant (26.6% vs. 24.9%; P=0.011). In the first year after the fracture, there were more new operations on hip and thigh in patients treated with an intramedullary implant (11.1% vs. 8.9%; P
PubMed ID
22921205 View in PubMed
Less detail

Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement.

https://arctichealth.org/en/permalink/ahliterature120198
Source
J Orthop Surg Res. 2012;7:33
Publication Type
Article
Date
2012
Author
Vikas Karade
B. Ravi
Manish Agarwal
Author Affiliation
Department of Mechanical Engineering, Indian Institute of Technology Bombay, 400076 Mumbai, Maharashtra, India. vikas_karade@iitb.ac.in
Source
J Orthop Surg Res. 2012;7:33
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Arthroplasty, Replacement, Knee - instrumentation - methods
Child
Female
Fracture Fixation, Intramedullary - instrumentation - methods
Humans
Knee Prosthesis
Male
Retrospective Studies
Tibia - radiography - surgery
Young Adult
Abstract
In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements.
A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software.
There was more varus placement in coronal plane with extramedullary cutting guide (-1.18 +/- 2.4 degrees) than the intramedullary guide (-0.34 +/- 2.31 degrees) but this did not reach statistical significance. The goal of 90 +/- 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/- 2.4 degrees) than intramedullary guide (0.50 +/- 3.80 degrees) for tibial component alignment, though 78% of patients were aligned within the goal of 0-5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups.
Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.
Notes
Cites: J Arthroplasty. 2007 Feb;22(2):219-2617275637
Cites: Knee. 2006 Jan;13(1):1-616051492
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Cites: J Arthroplasty. 1998 Aug;13(5):552-89726321
Cites: Knee. 2003 Sep;10(3):243-712893146
Cites: J Bone Joint Surg Br. 2002 Aug;84(6):858-6012211678
Cites: J Orthop Surg Res. 2011;6:4421854636
Cites: Knee. 2011 Oct;18(5):300-520926299
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Cites: Obes Surg. 2008 Dec;18(12):1599-60418516654
Cites: Knee Surg Sports Traumatol Arthrosc. 2008 Jul;16(7):670-318478202
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Cites: J Arthroplasty. 2008 Jun;23(4):586-9218514879
Cites: Knee. 2001 Jun;8(2):139-4411337241
PubMed ID
23031403 View in PubMed
Less detail

Fibular nailing for fixation of ankle fractures in patients at high risk of surgical wound infection.

https://arctichealth.org/en/permalink/ahliterature311065
Source
Foot Ankle Surg. 2020 Oct; 26(7):784-789
Publication Type
Journal Article
Date
Oct-2020
Author
Sini Karkkola
Tero Kortekangas
Harri Pakarinen
Tapio Flinkkilä
Jaakko Niinimäki
Hannu-Ville Leskelä
Author Affiliation
Oulu University Hospital, Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu, Finland; Medical Research Center, University of Oulu, Oulu, Finland. Electronic address: sini.karkkola@ppshp.fi.
Source
Foot Ankle Surg. 2020 Oct; 26(7):784-789
Date
Oct-2020
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ankle Fractures - diagnosis - surgery
Ankle Joint - diagnostic imaging - physiopathology - surgery
Bone Nails
Cone-Beam Computed Tomography
Female
Fibula - diagnostic imaging - injuries - surgery
Finland - epidemiology
Follow-Up Studies
Fracture Fixation, Intramedullary - adverse effects - methods
Humans
Incidence
Male
Middle Aged
Quality of Life
Range of Motion, Articular
Retrospective Studies
Surgical Wound Infection - epidemiology - etiology
Time Factors
Treatment Outcome
Young Adult
Abstract
Postoperative infection is a severe complication after operative treatment of ankle fractures, associated with age, comorbidities, and severe soft tissue injuries. We assessed the efficacy of intramedullary fibular nailing for treating ankle fractures in patients at high risk of wound complications.
41 high-risk patients were included in the study. We retrospectively reviewed the medical records to assess the risk profile, the treatment data, and possible infections and re-operations. After a minimum of 2 years eight patients had died, three had advanced-staged dementia and two were lost to follow-up. Remaining 28 patients reported the functional outcome and QoL through patient-reported questionnaires. Radiographs and cone-beam computed tomography were performed, as well as range-of-motion was measured.
No surgical wound infections were found. The mean Olerud-Molander score was 67 points (SD 28 [20-100]). The osteoarthritis stages and the range-of-motion were significantly different between the injured and uninjured ankles, but we detected no significant effect on the QoL.
Intramedullary fibular fixation appeared to be a safe treatment choice for ankle fractures in high-risk patients.
IV.
PubMed ID
31734044 View in PubMed
Less detail

38 records – page 1 of 4.