SLR - November 2023 - Hameed
Title: Ankle fractures: High implant cost is not associated with better patient reported outcomesReference: Kibble KM, Cunningham BP, Rivard RL, Vang S, Nguyen MP. Ankle fractures: High implant cost is not associated with better patient reported outcomes. Injury. 2023 Oct;54(10):110963. doi: 10.1016/j.injury.2023.110963. Epub 2023 Jul 26. PMID: 37542790.
Level of Evidence: II
Scientific Literature Review
Reviewed By: Nadia Hameed DPM
Residency Program: Long Island Jewish Forest Hills
Podiatric Relevance: This article reviews if cost of hardware affects the patient reported outcomes with ankle fracture treated with ORIF. Ankle fractures are a common injury and recently there is new hardware being introduced from companies. This article looks to explore the relevance of cost of hardware with patient outcomes.
Methods: This study aimed to discuss the effects of cost of hardware used in ankle fractures on patient reported outcomes. Studies have found that utilization of a locking or anatomic plate increases cost compared to non locking plates, syndesmotic screws and suture button fixation methods. This study utilized The Foot and Ankle Ability Measure – Activities of Daily Living (FAAM-ADL) to assess patient reported outcomes. Ankle fractures with ORIF performed at a Trauma level I were evaluated for type of fracture pattern type, type of fixation used with their implant model numbers to produce a manufactures price. The FAAM-ADL were determined for patients following six months.
Results: Trimalleolar fractures were the most expensive to treat due to more hardware being used to fixate it. There was no correlation between the cost of the hardware with the patient reported outcomes. Patients with Osteoporosis/ Osteopenia has no correlation with increased cost.
Conclusions: Authors concluded that cost of hardware does not correlate with better outcomes for patients. This may be beneficial when treating patients to opt for hardware that may lower the cost of the total surgery. Often, ambulatory surgery centers will not approve certain hardware due to the cost. This article explains that the cost of the hardware does not contribute to better outcomes and can serve as an incentive for surgeons to opt to use hardware that is less costly. Medical representatives will often try to promote their expensive hardware.