Department of Orthopaedic Surgery, Woodland Health Campus, National Healthcare Group, Singapore.
Health Services and Outcomes Research, National Health Care Group, Singapore.
J Shoulder Elbow Surg. 2020 Nov;29(11):2347-2352. doi: 10.1016/j.jse.2020.05.035. Epub 2020 Jun 19.
The ideal implant for stable, noncomminuted olecranon fractures is controversial. Tension band wiring (TBW) is associated with lower cost but higher implant removal rates.On the other hand, plate fixation (PF) is purported to be biomechanically superior, with lower failure and implant removal rates, although associated with higher cost. The primary aim of this study is to look at the clinical outcomes for all Mayo 2A olecranon between PF and TBW. The secondary aim is to perform an economic evaluation of PF vs. TBW.
This is a retrospective study of all surgically treated Mayo 2A olecranon fractures in a tertiary hospital from 2005-2016. Demographic data, medical history, range of motion, and complications were collected. All inpatient and outpatient costs in a 1-year period postsurgery including the index surgical procedure were collected via the hospital administrative cost database (normalized to 2014).
A total of 147 cases were identified (94 TBW, 53 PF). PF was associated with higher mean age (P < .01), higher American Society of Anesthesiologists score (P < .01), and higher proportion of hypertensives (P = .04). There was no difference in the range of motion achieved at 1 year for both groups. In terms of complications, TBW was associated with more symptomatic hardware (21.6% vs. 13.7%, P = .24) and implant failures (16.5% vs. none, P < .01), whereas the plate group had a higher wound complication (5.9% vs. none, P = .02) and infection rate (9.8% vs. 3.1%, P = .09). TBW had a higher implant removal rate of 30.9% compared with 22.7% for PF (P = .36). PF had a higher cost at all time points, from the index surgery ($10,313.64 vs. $5896.36, P < .01), 1-year cost excluding index surgery ($5069.61 vs. $3850.46, P = .46), and outpatient cost ($1667.80 vs. $1613.49, P = .27).
Based on our study results, we have demonstrated that TBW is the ideal implant for Mayo 2A olecranon fractures from both a clinical and economic standpoint, with comparable clinical results, potentially similar implant removal rates as PF's, and a lower cost over a 1-year period. In choosing the ideal implant, the surgeon must take into account, first, the local TBW and PF removal rate, which can vary significantly because of the patient's profile and beliefs, and second, the PF implant cost.
对于稳定的、非粉碎性尺骨鹰嘴骨折，理想的植入物仍存在争议。张力带钢丝固定（TBW）具有成本优势，但植入物取出率较高。另一方面，钢板固定（PF）被认为在生物力学上更优越，失败和植入物取出率较低，但成本较高。本研究的主要目的是比较 PF 和 TBW 治疗 Mayo 2A 尺骨鹰嘴骨折的临床结果。次要目的是对 PF 与 TBW 进行经济评估。
这是一项对 2005 年至 2016 年在一家三级医院接受手术治疗的 Mayo 2A 尺骨鹰嘴骨折的回顾性研究。收集了人口统计学数据、病史、活动范围和并发症。通过医院行政成本数据库收集术后 1 年内的所有住院和门诊费用（归一化为 2014 年）。
共确定了 147 例病例（94 例 TBW，53 例 PF）。PF 组的平均年龄较高（P<.01），美国麻醉医师协会评分较高（P<.01），高血压患者比例较高（P=0.04）。两组在 1 年时的活动范围无差异。在并发症方面，TBW 组有更多的症状性内固定物（21.6%比 13.7%，P=0.24）和植入物失败（16.5%比无，P<.01），而钢板组的伤口并发症（5.9%比无，P=0.02）和感染率（9.8%比 3.1%，P=0.09）较高。TBW 的植入物取出率为 30.9%，而 PF 为 22.7%（P=0.36）。PF 在所有时间点的成本都较高，包括指数手术（$10,313.64 比 $5896.36，P<.01）、不包括指数手术的 1 年成本（$5069.61 比 $3850.46，P=0.46）和门诊费用（$1667.80 比 $1613.49，P=0.27）。
根据我们的研究结果，我们已经证明，从临床和经济角度来看，TBW 是 Mayo 2A 尺骨鹰嘴骨折的理想植入物，具有可比的临床结果，与 PF 相比，潜在的植入物取出率相似，在 1 年内的成本较低。在选择理想的植入物时，外科医生必须首先考虑局部 TBW 和 PF 的取出率，这可能因患者的特征和信念而有很大差异，其次要考虑 PF 植入物的成本。
