# Surgical management for displaced pediatric proximal humeral fractures: a cost analysis

Journal of Children's Orthopaedics, Feb 2015

Purpose The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). Methods A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leaving the pins exposed (PPE) versus leaving the pins buried (PPB). Finally, sensitivity analyses were performed, assessing the cost-effectiveness of each technique when infection rates and cost of deep infections were varied. Results A total of 84 patients with displaced PPHF underwent surgical stabilization. A total of 35 cases were treated with IMN, 32 with PPE, and 17 with PPB. The age, sex, and preoperative fracture angulation were similar across all groups. A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02). Surgical time and estimated blood loss was higher in the IMN group (p < 0.001 and p = 0.01, respectively). The decision analysis revealed that the PPE technique resulted in an average cost saving of $4,502 per patient compared to IMN and$2,066 compared to PPB. This strategy remained cost-effective even when the complication rates with exposed implants approached 55 %. Conclusions Leaving pins exposed after surgical fixation of PPHF is more cost-effective than either burying pins or using intramedullary fixation.

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Benjamin J. Shore, Daniel J. Hedequist, Patricia E. Miller, Peter M. Waters, Donald S. Bae. Surgical management for displaced pediatric proximal humeral fractures: a cost analysis, Journal of Children's Orthopaedics, 2015, 55-64, DOI: 10.1007/s11832-015-0643-2