Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study.

UNLABELLED: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness. INTRODUCTION: The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. METHODS: The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data. RESULTS: Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %. CONCLUSIONS: The main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

Rigidity of unilateral external fixators--a biomechanical study.

INTRODUCTION: External fixation is the primary choice of temporary fracture stabilisation for specific polytrauma patients. Adequate initial fracture healing requires sufficient stability at the fracture site. The purpose of this study was to compare the rigidity of the Dynafix DFS(®) Standard Fixator (4 joints) with the Orthofix ProCallus Fixator(®) (2 joints), which differ in possibilities for adapting the configuration for clinical needs. MATERIALS AND METHODS: Both devices were tested 10 times in a standardised model. In steps of 10N, loading was increased to a maximum of 160N in parallel, transversal and axial direction (distraction and compression). Translation resultant and rotation resultant were calculated. RESULTS: With a force of 100N in parallel direction the mean translation resultant (Tr(mean)) of the Dynafix DFS(®) Standard Fixator (6.65±1.43mm) was significantly higher than the ProCallus Fixator(®) (3.29±0.83mm, p<0.001; Student's t-test). With a maximum load of 60N in transverse direction the Tr(mean) of the Dynafix DFS(®) Standard Fixator was significantly lower (8.14±1.20mm versus 9.83±0.63mm, p<0.005). Translation was significantly higher with the Dynafix DFS(®) Standard Fixator, for both distraction (2.13±0.32mm versus 1.69±0.44mm, p<0.05) and compression (1.55±1.08mm versus 0.15±0.33mm, p<0.005). The mean rotation resultant (Rr(mean)) at 160N distraction was lower for the Dynafix DFS(®) Standard Fixator (0.70±0.17° versus 0.97±0.21°, p<0.005). CONCLUSIONS: Both fixators were most sensitive to transverse forces. The Dynafix DFS(®) Standard Fixator was less rigid with parallel and axial forces, whereas transverse forces and rotation at distraction forces favoured the Dynafix DFS(®) Standard Fixator. Repeated heavy loading did not influence the rigidity of both devices.