Cost Comparison for Treatment of Single-Bone Metacarpal Fractures with Intramedullary Nail Versus Plate and Screw Fixation
Scott Stegemann*, Aparajit Naram
Surgery, Baystate Medical Center, Springfield, MA
Metacarpal fracture is the most common traumatic orthopedic hand injury, accounting for 18-44% of hand fractures with an incidence of 13.6 per 100,000. Traditional surgical fixation options include percutaneous Kirschner wire, plate and screw and retrograde intramedullary nail (IMN). This investigation aimed to compare the cost of care, rate of complications and subjective outcomes of care between plate and screw and IMN fixation
This was a retrospective study of patients seen at a tertiary medical center between January 2015 and December 2021. We included patients with an isolated metacarpal fracture (ICD10 S62.309A) who received open reduction internal fixation (CPT 26615) with either plate and screw or IMN fixation. The primary outcome was total out-of-pocket patient cost, with secondary outcomes including total cost of care, rate of major/minor complications and time to discharge from practice
A total of 200 patient met inclusion criteria (plate and screw n=100; IM nail n=100). There was a significant difference in out-of-pocket cost between plate and screw [$4,417.3 (95%CI: $3,807.9-$5,026).7] and IMN [$3,462.8 (95%CI: $3,127-$3,798, p=0.01]. Significant differences were also seen between total cost of care [plate and screw $12,549.6 (95%CI: $11,861.4-$13,237.8; IMN $8,812.1 (95%CI: $8,304.7-$9,319.4, p=0.00)], major complication rate [plate and screw 28 (95%CI: 20.4-38.3%); IMN 12 (6.9-20.0%) p=0.00], minor complication rate [plate and screw 56 (47.1-66.6%); IMN 41 (31.8-50.9%) p=0.02], operative time [plate and screw 1.2 hours (95%CI: 1.1-1.3); IMN 0.8 hours (95%CI: 0.7-0.9, p=0.00)] and number of postop x-rays [plate and screw 3.6 (95%CI: 3.2-4.0); IMN 2.2 (95%CI: 1.9-2.5, p=0.00)]
Though implant costs are higher, intramedullary nail fixation has a reduced out of pocket patient cost and total cost of care compared to plate and screw fixation in the setting of isolated metacarpal fracture. These findings can be attributed to reduced complication rate, operative time and adjuvant postoperative therapy in the IMN group compared to plate and screw fixation
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