Cost and Complications of Percutaneous Fixation of Hand Fractures in a Procedure Room Versus the Operating Room.

BACKGROUND: The purpose of this study was to compare closed reduction and percutaneous pinning of metacarpal and phalanx fractures performed in the operating room (OR) versus the procedure room of the emergency department with primary outcomes being infection rate, radiographic union, and monetary cost. METHODS: From January 2006 to December 2010, all closed reduction and percutaneous pinnings of metacarpal and phalanx fractures (CPT codes: 26608; 26727) by a single board-certified hand surgeon (A.M.H.) were retrospectively reviewed. Patients were placed into 2 groups: Group 1 was patients treated in the OR, and group 2 was patients in an emergency department procedure room. Infection, malunion, and nonunion rates were compared using a chi-square test. Charges were compared using a t-test, and cost of supplies and labor was evaluated. RESULTS: A total of 189 patients met final inclusion criteria for this study: 130 in group 1 and 59 in group 2. There was no statistically significant difference in infection rates ( P = .13), nonunion ( P = .40), malunion rates ( P = .89), and hardware failure with revision ( P = .94) between the 2 groups. The procedure room patients had an average hospital charge of $1358.55 compared with $3691.85 for OR-treated patients (P = .001). The total cost of supplies and nonphysician labor was $432.31 per OR case and $179.59 per procedure room case. CONCLUSIONS: Metacarpal and phalanx fractures of the hand amendable to closed reduction and percutaneous pinning can be treated in the procedure room with no increase in risk of infection, malunion, or nonunion rates. In addition, these surgeries can be performed in a procedure room with lower cost and less charges to patients than in the operating room.

Ray Resections of the Fingers: Indications, Techniques, and Outcomes.

Ray resection, which was pioneered by Bunnell in the 1920s, was initially performed as a salvage procedure for dysfunction of the proximal interphalangeal joint. Successful ray resection with or without an adjacent ray transfer can be useful for treating vascular insufficiency, tumors, infection, trauma, recurrent Dupuytren contracture, and congenital abnormalities of the hand. Indications, techniques, and outcomes vary based on the digit and the number of digits resected. Compared with amputation at the proximal phalangeal level, a single ray resection has better cosmesis and similar function, resulting in improved patient satisfaction. However, a 15% to 30% loss in grip and pinch strength has been reported. Today, ray resection results in good cosmetic and functional outcomes when preservation of a functional digit is unattainable or when the presence of an abnormal, unreconstructable digit interferes with the overall hand function.