Choo Stephanie, Faust Amanda, Troyer Luke, Philips Rachel, London Daniel A, Nuelle Julia A V
University of Missouri, Columbia, USA.
Hand (N Y). 2025 Jan 6:15589447241306147. doi: 10.1177/15589447241306147.
Intramedullary screw (IMS) fixation for metacarpal fractures is a relatively new fixation technique in comparison to plate and screw constructs. Our hypothesis evaluated whether IMS fixation for metacarpal fractures results in lower overall health care-associated costs in comparison to open reduction and internal fixation (ORIF).
A retrospective review of patients undergoing IMS fixation for metacarpal fractures at a single center during 2018 to 2022 was conducted. Health care-associated costs included primary operative costs (surgical time and implant(s)) and postoperative costs (therapy, splinting, and radiology). Costs were compared with age-matched and fracture pattern-matched controls who underwent ORIF with plate and screw construct. Subgroup analysis of cost outcomes excluding outliers was completed.
Eight subjects met the inclusion criteria and matched with an ORIF group. Primary operative costs were significantly higher in the ORIF group (mean difference of $1830, 95% CI: $1006 to $2653) The cost of an IMS at our institution was $584, whereas the average cost for plate and screw construct was $2538 (mean difference of $1953, 95% CI: $1665 to $2243). Total surgical costs were on average $3784 more for the ORIF group (95% CI: $2869 to $4700). There was no significant difference in outpatient follow-up costs (95% CI: -$441 to $3180). Total overall costs were significantly lower for the IMS group (95% CI: $2693 to $6513).
Total primary operative costs and overall health care-associated costs for IMS fixation of metacarpal fractures is significantly lower than ORIF. There was no statistical difference in follow-up care costs. To better determine the indirect costs for patients, high-powered prospective studies will be required.
与钢板螺钉固定结构相比，髓内螺钉（IMS）固定掌骨骨折是一种相对较新的固定技术。我们的假设是评估与切开复位内固定（ORIF）相比，IMS固定掌骨骨折是否会降低总体医疗相关成本。
对2018年至2022年期间在单一中心接受IMS固定掌骨骨折的患者进行回顾性研究。医疗相关成本包括主要手术成本（手术时间和植入物）和术后成本（治疗、夹板固定和放射检查）。将成本与年龄匹配和骨折类型匹配的接受钢板螺钉结构ORIF的对照组进行比较。完成了排除异常值的成本结果亚组分析。
8名受试者符合纳入标准，并与ORIF组匹配。ORIF组的主要手术成本显著更高（平均差异为1830美元，95%置信区间：1006美元至2653美元）。我们机构的一枚IMS成本为584美元，而钢板螺钉结构的平均成本为2538美元（平均差异为1953美元，95%置信区间：1665美元至2243美元）。ORIF组的总手术成本平均高出3784美元（95%置信区间：2869美元至4700美元）。门诊随访成本没有显著差异（95%置信区间：-441美元至3180美元）。IMS组的总总体成本显著更低（95%置信区间：2693美元至6513美元）。
IMS固定掌骨骨折的总主要手术成本和总体医疗相关成本显著低于ORIF。随访护理成本没有统计学差异。为了更好地确定患者的间接成本，将需要进行有强大效力的前瞻性研究。
