Construct Choice for the Treatment of Displaced, Comminuted Olecranon Fractures: are Locked Plates Cost Effective?

BACKGROUND: Cost effective implant selection in orthopedic trauma is essential in the current era of managed healthcare delivery. Both locking and non-locking plates have been utilized in the treatment of displaced fractures of the olecranon. However, locking plates are often more costly and may not provide superior clinical outcomes. The primary aim of the present study is to assess the clinical and functional outcomes of olecranon fractures treated with locked and non-locking plate and screw constructs while providing insight into the cost of various implants. METHODS: We performed a retrospective chart review of a single institution database identifying Mayo IIB type olecranon fractures treated surgically from 2003 to 2012. All fractures were treated with either a locked plate or a one-third tubular hook plate construct. Clinical and radiographic outcomes were evaluated. Minimum 6-month follow-up was required. Outcomes were compared between fixation constructs, including rate of union, early failure, postoperative range of motion, and complication rates. Statistical analysis included Pearson's Chi-squared and Fisher's exact test for categorical variables, and the Student's ttest for continuous variables. RESULTS: The one-third tubular construct was equivalent to locking plate constructs with respect to union, post-operative range of motion, and rates of complications. There were no early or late failures. Locking plates were associated with a relative cost increase of $1,263.50 compared to the one-third tubular hook plate per case. CONCLUSION: Surgeons should consider the cost of implants when treating Mayo IIB olecranon fracture. In this cohort, one-third tubular plates provided equivalent outcomes to locked plates with a notable decrease in cost.

An analysis of the actual cost of tibial nonunions.

The financial and medical records of 11 patients diagnosed with a tibial nonunion were evaluated in order to assess the costs associated with the care of this clinical entity. The initial tibia fractures were seen at Hermann Hospital (Houston, Texas) between April 1991 and June 1993. We included only those patients who had a diagnosis of tibial shaft nonunion which we defined as a tibial fracture which was without radiographic or clinical evidence of progressive healing 6 months after the initial injury. A total of 9 patients were available for evaluation and 2 were lost to follow-up.