There has been an increase in the number of clavicle fractures that are treated operatively over the past decade. While there is good literature to support that certain patterns may benefit from operative fixation, there is a sense from some in the orthopaedic trauma community that the pendulum has swung too far to the side of operative treatment.
In the April issue of JOT, authors from LSU look at another aspect of the debate in their paper “A Cost Analysis of Internal Fixation Versus Nonoperative Treatment
in Adult Midshaft Clavicle Fractures Using Multiple Randomized
Controlled Trials.” The authors conclude that from the perspective of a single payer, initial nonoperative treatment of midshaft clavicle fractures followed by delayed surgery as needed is less costly than initial operative fixation.
In his invited commentary, Peter Althausen raises several significant concerns with the model that the authors utilize to come to their conclusions. Some of the issues include cost allocation, only looking at the payer perspective and not the patient/society, and implant costs. He goes on to state that cost analysis outcomes include much more than the initial cost to payers.
The authors offer a rebuttal to address each of the comments, to which Dr. Althausen offers an additional reply. But the debate does not have to end there. What do you think about the article? How should we evaluate the value of fracture fixation with respect to costs? Please share your comments below.
Hassan R. Mir, MD, MBA, FACS
Editor | OsteoSynthesis – The JOT Online Discussion Forum