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
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Article info
Publication history
Published online: February 09, 2022
Accepted:
December 15,
2021
Received:
March 31,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
