Economic considerations on avoiding implant removals after fracture fixation by using absorbable devices.

Pins and screws for internal fracture fixation made of absorbable polymers have been available since the latter half of the 1980s. When using these implants there is no need for a subsequent implant removal operation. During the 7-year period 1985-1991, a total of 1219 patients were treated with such absorbable fixation devices, the most common indications being displaced malleolar fractures of the ankle and fractures of the radial head. Considering the economic viewpoints, the high acquisition costs of the absorbable implants partially outweighed the benefit of avoiding all removal procedures. When all costs also for the implant removal procedure after metallic fixation were included, the average cost saved per patient by using absorbable implants in a trimalleolar fracture was FIM 2023 (4.4% of the total costs). However, the removal of metallic devices is in fact to some degree optional, and in case the metallic implants were not removed, the economic result was in favor of the metallic devices by FIM 3684 per patient. Consequently, the ultimate economic audit of the use of absorbable vs. metallic devices is linearly dependent on the actual implant removal frequency. According to the present cost analysis, the break-even point would be attained at a removal rate of 65% in trimalleolar ankle fractures, at 51% in uni-and bimalleolar fractures and at 30% in fractures of the radial head. Only at a higher removal rate the introduction of absorbable devices would be a financially more favorable alternative.