Ankle fractures: High implant cost is not associated with better patient reported outcomes |
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| Institution: | 1. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America;2. Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, MN, United States of America;3. Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, United States of America;4. Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, United States of America;1. R Adams Cowley Shock Trauma Center, University of Maryland, MD, 22 S Greene St, Baltimore, MD 21201, USA;2. Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada;3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada;4. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA;5. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;6. Department of Orthopaedic Surgery, Section of Orthopaedic Trauma, Duke University, Durham, North Carolina;7. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA;8. Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA;1. Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, Sichuan Province, China;2. Shanghai Jiao Tong University Affiliated Sixth People''s Hospital, 600 Yishan Road, Shanghai, 200235, China;3. Department of Orthopaedic Surgery, Atrium Health Navicent, Macon, Georgia;4. OrthoCarolina Research Institute Charlotte, NC;5. Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.;6. Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Annandale, VA, USA.;1. Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina;2. Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Annandale, VA, USA;1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;3. Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan;1. College of Medicine, King Saud bin Abdulaziz University for health Sciences, Jeddah, Saudi Arabia;2. King Abdullah International Medical Research Center, Jeddah, Saudi Arabia;3. Orthopedic Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia;1. Department of Septic Bone and Joint Surgery, BG Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany;2. Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany;3. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany |
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| Abstract: | IntroductionAnkle fractures comprise 9% of all fractures and are among the most common fractures requiring operative management. Open reduction and internal fixation (ORIF) with plates and screws is the gold standard for the treatment of unstable, displaced ankle fractures. While performing ORIF, orthopaedic surgeons may choose from several fixation methods including locking versus nonlocking plating and whether to use screws or suture buttons for syndesmotic injuries.Nearly all orthopaedic surgeons treat ankle fractures but most are unfamiliar with implant costs. No study to date has correlated the cost of ankle fracture fixation with health status as perceived by patients through patient reported outcomes (PROs). The purpose of this study was to determine whether there is a relationship between increasing implant cost and PROs after a rotational ankle fracture.MethodsAll ankle fractures treated with open reduction internal fixation (ORIF) at a level I academic trauma center from January 2018 to December 2022 were identified. Inclusion criteria included all rotational ankle fractures with a minimum 6-month follow-up and completed 6-month PRO. Patients were excluded for age <18, polytrauma and open fracture. Variables assessed included demographics, fracture classifications, Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL) score, implant type, and implant cost.ResultsThere was a statistically significant difference in cost between fracture types (p < 0.0001) with trimalleolar fractures being the most expensive. The mean FAAM-ADL score was lowest for trimalleolar fractures at 78.9, 95% CI 75.5, 82.3]. A diagnosis of osteoporosis/osteopenia was associated with a decrease in cost of $233.3, 95% CI ?411.8, ?54.8]. There was no relationship between syndesmotic fixation and implant cost, $102.6, 95% CI ?74.9, 280.0]. There was no correlation between implant cost and FAAM-ADL score at 6 months (p = 0.48).ConclusionsThe utilization of higher cost ankle fixation does not correlate with better FAAM-ADL scores. Orthopaedic surgeons may choose less expensive implants to improve the value of ankle fixation without impacting patient reported outcomes. |
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