Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2015; 6(1): 145-149
Published online Jan 18, 2015. doi: 10.5312/wjo.v6.i1.145
Cost of external fixation vs external fixation then nailing in bone infection
Khaled Mohamed Emara, Ramy Ahmed Diab, Khaled Abd EL Ghafar
Khaled Mohamed Emara, Ramy Ahmed Diab, Khaled Abd EL Ghafar, Orthopaedic Surgery, Ain Shams University, Cairo 0020, Egypt
Author contributions: Emara KM designed and wrote up the research; Diab RA collected the data and wrote up the research; Ghafar KAE collected the data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ramy Ahmed Diab, Lecturer, Orthopaedic Surgery, Ain Shams University, 13 B Kornish el, Nile, Agha Khan, Cairo 0020, Egypt. ramydiab79@gmail.com
Telephone: +20-2-22055661 Fax: +20-2-22055662
Received: April 25, 2014
Peer-review started: April 27, 2014
First decision: May 14, 2014
Revised: May 29, 2014
Accepted: September 16, 2014
Article in press: September 17, 2014
Published online: January 18, 2015
Abstract

AIM: To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment transfer.

METHODS: Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups.

RESULTS: The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care (surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc.) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM nail.

CONCLUSION: Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities.

Keywords: Cost, Fixator, Nailing, Infection

Core tip: Fifty patients with infected nonunion tibia (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance and health authorities.