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Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment
Abstract
Objective: Economic considerations are an essential part of good surgical practice especially in the face of ever rising cost of health care in a depressed economy. This paper compares the cost effectiveness of compression plating and traction in paediatric femoral shaft fractures.
Methods: A-ten-year comparative multi-centre study in which children 5-16 years who had open reduction and internal fixation (ORIF) with dynamic compression plates were compared with children who had conservative management by traction. A cost analysis was done using duration of hospitalization and direct cost as economic indices. Patients were matched for age, sex, area and type of fracture, cause of injury (one case of osteogenesis imperfecta is on record) and indication for surgery.
Results: Thirty-one patients who had ORIF and 31 matched controls were recruited from a pool of 775 children who sustained femoral fractures over the study period. There were 42 (67.7%) males and 20 (32.3%) females. Forty-seven (71.0%) resulted from road traffic accidents, 17 (27.4%) from fall from heights and one (1.6%) pathological fracture from osteogenesis imperfecta. The right femur was affected in 34 (54.8%) and the left in 28 (45.2%) cases. The commonest type of fracture was oblique in 30 (48.4%), transverse in 19 (30.6%) and spiral in 13 (21.0%) patients. The mean duration of hospital stay for ORIF was 3.9(±1.7) and 6.4(±1.2) weeks for the conservative group (p<0.001). The mean cost of treatment was N27, 844.00 (±7,600) ($206.03) for ORIF and N17, 315.60 (±5,300) ($123.70) for the conservative group( p<0.001).
Conclusion: The cost of open reduction and internal fixation with dynamic compression plates and screws is 38% more expensive than conservative treatment using traction in spite of the longer duration of hospitalization. This is accounted for by the cost of implants and antibiotics.
Keywords: pediatric femoral shaft, dynamic compression plate, traction, cost
Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 274-277
Methods: A-ten-year comparative multi-centre study in which children 5-16 years who had open reduction and internal fixation (ORIF) with dynamic compression plates were compared with children who had conservative management by traction. A cost analysis was done using duration of hospitalization and direct cost as economic indices. Patients were matched for age, sex, area and type of fracture, cause of injury (one case of osteogenesis imperfecta is on record) and indication for surgery.
Results: Thirty-one patients who had ORIF and 31 matched controls were recruited from a pool of 775 children who sustained femoral fractures over the study period. There were 42 (67.7%) males and 20 (32.3%) females. Forty-seven (71.0%) resulted from road traffic accidents, 17 (27.4%) from fall from heights and one (1.6%) pathological fracture from osteogenesis imperfecta. The right femur was affected in 34 (54.8%) and the left in 28 (45.2%) cases. The commonest type of fracture was oblique in 30 (48.4%), transverse in 19 (30.6%) and spiral in 13 (21.0%) patients. The mean duration of hospital stay for ORIF was 3.9(±1.7) and 6.4(±1.2) weeks for the conservative group (p<0.001). The mean cost of treatment was N27, 844.00 (±7,600) ($206.03) for ORIF and N17, 315.60 (±5,300) ($123.70) for the conservative group( p<0.001).
Conclusion: The cost of open reduction and internal fixation with dynamic compression plates and screws is 38% more expensive than conservative treatment using traction in spite of the longer duration of hospitalization. This is accounted for by the cost of implants and antibiotics.
Keywords: pediatric femoral shaft, dynamic compression plate, traction, cost
Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 274-277
