Das De Soumen, Bae Donald S, Waters Peter M
Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
J Pediatr Orthop. 2012 Sep;32(6):573-8. doi: 10.1097/BPO.0b013e318263a25f.
The purpose of this investigation was to determine if leaving Kirschner wires exposed is more cost-effective than burying them subcutaneously after open reduction and internal fixation (ORIF) of humeral lateral condyle fractures.
A retrospective cohort study of all lateral condyle fractures treated over a 10-year period at a single institution was performed. Data on surgical technique, fracture healing, and complications were analyzed, as well as treatment costs. A decision analysis model was then constructed to compare the strategies of leaving the pins exposed versus buried. Finally, sensitivity analyses were performed, assessing cost-effectiveness when infection rates and costs of treating deep infections were varied.
A total of 235 children with displaced fractures were treated with ORIF using Kirschner wires. Pins were left exposed in 41 cases (17.4%) and buried in 194 cases (82.6%); the age, sex, injury mechanisms, and fracture patterns were similar in both the groups. The median time to removal of implants was shorter with exposed versus buried pins (4 vs. 6 wk, P<0.001), although there was no difference in fracture union or loss of reduction rates. The rate of superficial infection was higher with exposed pins (9.8% vs. 3.1%), but this was not statistically significant (P=0.076). There were no deep infections with exposed pins, whereas the rate of deep infection was 0.5% with buried pins (P=1.00). Buried pins were associated with additional complications, including symptomatic implants (7.2%); pins protruding through the skin (16%); internal pin migration necessitating additional surgery (1%); and skin necrosis (1%). The decision analysis revealed that leaving pins exposed resulted in an average cost savings of $3442 per patient. This strategy remained cost-effective even when infection rates with exposed pins approached 40%.
Leaving the pins exposed after ORIF of lateral condyle fractures is safe and more cost-effective than burying the pins subcutaneously.
Retrospective cohort study (level III).
本研究旨在确定肱骨外侧髁骨折切开复位内固定（ORIF）后克氏针外露是否比皮下埋藏更具成本效益。
对某单一机构10年间治疗的所有外侧髁骨折进行回顾性队列研究。分析手术技术、骨折愈合及并发症数据，以及治疗费用。然后构建决策分析模型，比较克氏针外露与埋藏两种策略。最后进行敏感性分析，评估感染率和深部感染治疗费用变化时的成本效益。
共有235例移位骨折患儿接受了克氏针ORIF治疗。41例（17.4%）克氏针外露，194例（82.6%）克氏针埋藏；两组患儿的年龄、性别、损伤机制和骨折类型相似。与埋藏克氏针相比，外露克氏针的植入物取出中位时间更短（4周对6周，P<0.001），尽管骨折愈合或复位丢失率无差异。外露克氏针的浅表感染率更高（9.8%对3.1%），但差异无统计学意义（P=0.076）。外露克氏针未发生深部感染，而埋藏克氏针的深部感染率为0.5%（P=1.00）。埋藏克氏针还伴有其他并发症，包括植入物有症状（7.2%）；克氏针穿出皮肤（16%）；克氏针向内移位需再次手术（1%）；以及皮肤坏死（1%）。决策分析显示，克氏针外露使每位患者平均节省成本3442美元。即使外露克氏针的感染率接近40%，该策略仍具成本效益。
肱骨外侧髁骨折ORIF后克氏针外露比皮下埋藏更安全且更具成本效益。
回顾性队列研究（III级）。
