Cost Effectiveness of a New Ankle Fracture System

Background Ankle fractures are common injuries, and many have indications for operative treatment. Newer plate designs have recently been introduced and have the potential to simplify and shorten the operative procedure. This study compares the costs of operative treatment of a lateral malleolus fracture between a novel plate design and a neutralization plate and lag screw approach. Materials and Methods A retrospective chart review was performed with institutional review board approval. All patients operatively treated for a Weber B lateral malleolus fracture were divided into two cohorts: an experimental group treated with a novel plate and a control group treated with a lag screw and neutralization plate. Costs of implants, operating room costs and time to healing were compared between the two cohorts. Results The average implant cost for the novel plate design ($1,141) was significantly higher than that of the plate and lag screw construct ($208) (p<0.0001). The average operating room costs were significantly lower for the experimental group ($4,410) compared to the control group ($6,037) (p<0.01). The average time to healing was significantly less in the experimental group (75 days) than in the control group (97 days) (p<0.04). Conclusion The decreased operating room costs likely result from attributes of the novel plate design that assist in fracture reduction and eliminate the need for a separate lag screw. The decreased dissection required to apply the novel plate could explain the quicker healing observed. The additional cost of new implant designs may be justified by quicker, simpler operative techniques and enhanced healing. Originally published as Electronic Poster at AOFAS, Washington DC, July 7th 2010. Introduction Ankle fractures are among the most common injuries treated by orthopaedic surgeons, and the annual incidence of ankle fractures is rising. The indications for operative treatment of ankle fractures are well described. A displaced fracture of the lateral malleolus adjacent to the syndesmosis is one of the most common indications for operative treatment. This fracture can be described as a Weber B fracture in accordance with the classification described in 1977. Operative treatment of this fracture pattern requires anatomic reduction and rigid stabilization while the fracture heals. Generally these requirements are accomplished in accordance with well-described AO fracture fixation principles. After reduction of the fracture, an interfragmentary compression screw is applied using a lag screw technique. A neutralization plate is then applied to the lateral aspect of the fibula to protect the interfragmentary screw against rotational forces applied to the distal fibula. An accepted alternative to this technique is the application of an anti-glide plate to the posterior aspect of the fibula with an interfragmentary compression screw placed through the plate and across the fracture from posterior to anterior. Both of these techniques result in predictable healing in the vast majority of cases. Newer techniques and innovations in plate and screw design have emerged in recent years, and a number of these are specific to the treatment of displaced lateral malleolus fractures. The Sidewinder plate from the Trimed (Valencia, CA) ankle fixation system is one of these novel plate designs (Fig. 1). It incorporates tabs protruding from the leading and trailing edges of the implant. These tabs initially aid in reduction and are then crimped to the anterior and posterior aspects of the fibula to compress across the fracture site in lieu of an interfragmentary lag screw. The design of the plate has the potential to simplify the standard operative procedure by aiding in the reduction of the fracture. Furthermore, the operative time can be shortened since there is no need to place a lag screw separately from the plate. The purpose of this study is to compare the costs associated with operative treatment of a displaced lateral malleolus fracture with the novel Sidewinder plate to treatment with a traditional lag screw and neutralization plate. We hypothesize that there is no significant difference between the two treatment methods with respect to the combined cost of the implants and operating room time.