Cost analysis of managing paediatric femoral shaft fractures: flexible intramedullary nailing versus non-operative management.

This retrospective study aimed at comparing the cost of operative treatment versus non-operative treatment in the management of isolated paediatric femoral shaft fracture, in a single Trauma and Orthopaedic unit in a district general hospital in South East England. Patients were divided into three groups according to their treatment, and the cost was analysed depending on their requirements for hospital stay, theatre, physiotherapy, radiographs and plaster cast. Sixty-two children were admitted to our trauma unit with an isolated femoral shaft fracture from January 2001 to April 2005. There is a significant variation in the cost between the 16 patients treated with operative flexible nailing in comparison with those treated non-operatively either by traction alone (31 patients), or by traction followed by cast (15 patients). Operative treatment was shown to reduce the inpatient stay by approximately 75% (mean of 9.8 days in the operative group in comparison to 39.3 days in the non-operative group). It has also reduced the overall cost for treatment by more than 60% in comparison to traction alone and by almost 30% in comparison to using traction followed by casting.