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Cost Assessment of Plating Versus Tension Band Wiring Constructs for Treating Mayo Type 2A Olecranon Fractures

Published:February 09, 2022DOI:https://doi.org/10.1016/j.jhsa.2021.12.009

      Purpose

      Tension band wiring (TBW) or plating may be used for fixation with similar clinical outcomes for adults with displaced Mayo 2A olecranon fractures. The primary hypothesis is that total direct costs (TDCs) for surgery are lower for TBW than plating. Our secondary hypothesis is that combined surgical TDCs are lower for TBW even with a 100% rate of subsequent tension band hardware removal and a 0% rate of plate removal.

      Methods

      Patients who underwent TBW or plating of an isolated unilateral Mayo 2A olecranon fracture between July 2011 and January 2020 at a single academic medical center were identified. Then, TDC for each surgery on plate fixation, TBW, and hardware removal was obtained and converted to 2020 US dollars using information technology cost tools provided by our institution. Finally, relative TDCs were compared between plate fixation and TBW groups using univariate and multivariable generalized estimating equations with log-link.

      Results

      Of the 97 included patients, the mean age was 50 ± 21 years, and 48% were female. Tension band wiring and plate fixation were performed on 18% (17/97) and 82% (80/97) of male and female patients, respectively. Demographics were similar between groups, although the finding that plate fixation cost 2.6 times that of TBW within the index surgery was significant in the multivariable model, independent of potential confounders (coefficient 2.55, 95% confidence interval: 2.09–3.10). Additionally, mean TDC remained significantly greater for plate fixation even under the hypothetical situation where 100% TBW were removed, and the plate removal rate was 0% (cost difference 181%).

      Conclusions

      Using TBW relative to plate fixation may improve the cost of care for operative Mayo 2A olecranon fractures. Furthermore, this finding was robust to the rate of hardware removal.

      Type of study/level of evidence

      Economic and Decision Analyses III.

      Key Words

      JHS Podcast

      April 4, 2022

      JHS Podcast Episode 73

      Dr. Graham interviews Dr. Nik Kazmers about his article “Cost Assessment of Plating Versus Tension Band Wiring Constructs for Treating Mayo Type 2A Olecranon Fractures”, which appears in the April 2022 issue of the The Journal of Hand Surgery.

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      References

        • Wiegand L.
        • Bernstein J.
        • Ahn J.
        Fractures in brief: olecranon fractures.
        Clin Orthop Relat Res. 2012; 470: 3637-3641
        • Duckworth A.D.
        • Clement N.D.
        • Aitken S.A.
        • Court-Brown C.M.
        • McQueen M.M.
        The epidemiology of fractures of the proximal ulna.
        Injury. 2012; 43: 343-346
        • Holme T.J.
        • Karbowiak M.
        • Arnander M.
        • Gelfer Y.
        Paediatric olecranon fractures: a systematic review.
        EFORT Open Rev. 2020; 5: 280-288
        • Powell A.J.
        • Farhan-Alanie O.M.
        • Bryceland J.K.
        • Nunn T.
        The treatment of olecranon fractures in adults.
        Musculoskelet Surg. 2017; 101: 1-9
        • Putnam M.D.
        • Christophersen C.M.
        • Adams J.E.
        Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient.
        Shoulder Elbow. 2017; 9: 285-291
        • Duckworth A.D.
        • Bugler K.E.
        • Clement N.D.
        • Court-Brown C.M.
        • McQueen M.M.
        Nonoperative management of displaced olecranon fractures in low-demand elderly patients.
        J Bone Joint Surg Am. 2014; 96: 67-72
        • Duckworth A.D.
        • Clement N.D.
        • McEachan J.E.
        • White T.O.
        • Court-Brown C.M.
        • McQueen M.M.
        Prospective randomised trial of non-operative versus operative management of olecranon fractures in the elderly.
        Bone Joint J. 2017; 99: 964-972
        • Chen M.J.
        • Campbell S.T.
        • Finlay A.K.
        • Duckworth A.D.
        • Bishop J.A.
        • Gardner M.J.
        Surgical and non-operative management of olecranon fractures in the elderly: a systematic review and meta-analysis.
        J Orthop Trauma. 2020; 35: 10-16
        • Duckworth A.D.
        • Clement N.D.
        • White T.O.
        • Court-Brown C.M.
        • McQueen M.M.
        Plate versus tension-band wire fixation for olecranon fractures: a prospective randomized trial.
        J Bone Joint Surg Am. 2017; 99: 1261-1273
        • Nowak T.E.
        • Burkhart K.J.
        • Mueller L.P.
        • et al.
        New intramedullary locking nail for olecranon fracture fixation: an in vitro biomechanical comparison with tension band wiring.
        J Trauma. 2010; 69: E56-61
        • Bateman D.K.
        • Barlow J.D.
        • VanBeek C.
        • Abboud J.A.
        Suture anchor fixation of displaced olecranon fractures in the elderly: a case series and surgical technique.
        J Shoulder Elbow Surg. 2015; 24: 1090-1097
        • Newman S.D.
        • Mauffrey C.
        • Krikler S.
        Olecranon fractures.
        Injury. 2009; 40: 575-581
        • Amini M.H.
        • Azar F.M.
        • Wilson B.R.
        • Smith R.A.
        • Mauck B.M.
        • Throckmorton T.W.
        Comparison of outcomes and costs of tension-band and locking-plate osteosynthesis in transverse olecranon fractures: a matched-cohort study.
        Am J Orthop (Belle Mead NJ). 2015; 44: E211-215
        • Schliemann B.
        • Raschke M.J.
        • Groene P.
        • et al.
        Comparison of tension band wiring and precontoured locking compression plate fixation in Mayo type IIA olecranon fractures.
        Acta Orthop Belg. 2014; 80: 106-111
        • Ren Y.M.
        • Qiao H.Y.
        • Wei Z.J.
        • et al.
        Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis.
        J Orthop Surg Res. 2016; 11: 137
        • Tarallo L.
        • Mugnai R.
        • Adani R.
        • Capra F.
        • Zambianchi F.
        • Catani F.
        Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques.
        Arch Orthop Trauma Surg. 2014; 134: 1107-1114
        • Rantalaiho I.K.
        • Miikkulainen A.E.
        • Laaksonen I.E.
        • Äärimaa V.O.
        • Laimi K.A.
        Treatment of displaced olecranon fractures: a systematic review.
        Scand J Surg. 2019; 110: 13-21
        • Gathen M.
        • Jaenisch M.
        • Peez C.
        • et al.
        Plate fixation and tension band wiring after isolated olecranon fracture comparison of outcome and complications.
        J Orthop. 2019; 18: 69-75
        • Koziarz A.
        • Woolnough T.
        • Oitment C.
        • Nath S.
        • Johal H.
        Surgical management for olecranon fractures in adults: a systematic review and meta-analysis.
        Orthopedics. 2019; 42: 75-82
        • Francis T.
        • Washington T.
        • Srivastava K.
        • Moutzouros V.
        • Makhni E.C.
        • Hakeos W.
        Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating.
        J Shoulder Elbow Surg. 2017; 26: 1995-2003
        • Lee V.S.
        • Kawamoto K.
        • Hess R.
        • Park C.
        • Young J.
        • Hunter C.
        • et al.
        Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality.
        JAMA. 2016; 316: 1061-1072
        • Wilkerson J.A.
        • Rosenwasser M.P.
        Surgical techniques of olecranon fractures.
        J Hand Surg Am. 2014; 39: 1606-1614
        • Kazmers N.H.
        • Judson C.H.
        • Presson A.P.
        • Xu Y.
        • Tyser A.R.
        Evaluation of factors driving cost variation for distal radius fracture open reduction internal fixation.
        J Hand Surg Am. 2018; 43: 606-614.e1
        • Kazmers N.H.
        • Presson A.P.
        • Xu Y.
        • Howenstein A.
        • Tyser A.R.
        Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery.
        J Hand Surg Am. 2018; 43: 971-977.e1
        • Kazmers N.H.
        • Stephens A.R.
        • Presson A.P.
        • Yu Z.
        • Tyser A.R.
        Cost implications of varying the surgical setting and anesthesia type for trigger finger release surgery.
        Plast Reconstr Surg Glob Open. 2019; 7e2231
        • Kazmers N.H.
        • Lazaris E.L.
        • Allen C.M.
        • Presson A.P.
        • Tyser A.R.
        Comparison of surgical encounter direct costs for three methods of cubital tunnel decompression.
        Plast Reconstr Surg. 2019; 143: 503-510
        • Stephens A.R.
        • Yu Z.
        • Presson A.P.
        • Tyser A.R.
        • Kazmers N.H.
        Cost implications of varying the surgical setting and anesthesia type for de Quervain release surgery.
        J Wrist Surg. 2020; 9: 289-297
        • Feller R.
        • Illing D.
        • Allen C.
        • Presson A.
        • Tyser A.
        • Kazmers N.
        Evaluation of factors influencing surgical treatment costs for distal biceps rupture.
        J Shoulder Elbow Surg. 2020; 29: e229-e237
        • Kazmers N.H.
        • Stephens A.R.
        • Presson A.P.
        • Xu Y.
        • Feller R.J.
        • Tyser A.R.
        Comparison of direct surgical costs for proximal row carpectomy and four-corner arthrodesis.
        J Wrist Surg. 2019; 8: 66-71
        • Sullivan C.W.
        • Desai K.
        Classifications in brief: Mayo classification of olecranon fractures.
        Clin Orthop Relat Res. 2019; 477: 908-910
        • Manning W.G.
        • Mullahy J.
        Estimating log models: to transform or not to transform?.
        Journal of Health Econ. 2001; 20: 461-494
        • Rantalaiho I.K.
        • Laaksonen I.E.
        • Ryösä A.J.
        • Perkonoja K.
        • Isotalo K.J.
        • Äärimaa V.O.
        Complications and reoperations related to tension band wiring and plate osteosynthesis of olecranon fractures.
        J Shoulder Elbow Surg. 2021; 30: 2412-2417
        • Hahn A.
        • O'Hara N.N.
        • Koh K.
        • Zhang L.Q.
        • O'Toole R.V.
        • Eglseder W.A.
        Is intramedullary screw fixation biomechanically superior to locking plate fixation and/or tension band wiring in transverse olecranon fractures? A cadaveric biomechanical comparison study.
        Injury. 2020; 51: 850-855
        • Midtgaard K.S.
        • Søreide E.
        • Brattgjerd J.E.
        • Moatshe G.
        • Madsen J.E.
        • Flugsrud G.B.
        Biomechanical comparison of tension band wiring and plate fixation with locking screws in transverse olecranon fractures.
        J Shoulder Elbow Surg. 2020; 29: 1242-1248