Volar locking plates versus Kirschner wires for distal radial fractures-A cost analysis study

Background: There is an increasing trend for managing dorsally angulated distal radial fractures with locked volar plate fixation in fractures that may have previously been managed with percutaneous Kirschner wire (K-wire) fixation. There has been no prospective randomised trial comparing locked volar plate fixation with percutaneous K-wire fixation. in the absence of data guiding management with regard to clinical effectiveness, we have examined the cost of each technique. Methods: Patients' details were collected retrospectively between June 2007 and June 2008. Ten consecutive patients who underwent percutaneous K-wire fixation fora distal radius fracture and the 10 who were treated by locked volar plate fixation were identified and their hospital notes retrieved. All patients had a closed extra-articular distal radial fracture with dorsal angulation. The duration and type of operation, including number of wires or screws used, were recorded. Results: The mean age of the patients was 54 years for the locking plate group and 34 years for the percutaneous K-wire group. The mean time taken to perform percutaneous K-wire fixation with an average of two K-wires was 56 min. The mean time for applying a volar locked plate was 121 min. The cost of a pack of 10 K-wires was 3 pound. The total cost of a standard volar locking plate and screws used was 787 pound. Discussion: In the absence of research comparing clinical end points, cost must play a major factor in determining the type of operation offered. A 56-min operation to percutaneously fix a distal radial fracture with K-wires costs 662 pound. This compares to a cost of 2212 pound for a 121-min locked volar plate fixation. There is a calculated difference of 1549 pound and 65 min. Conclusion: With use of a locked volar plate for patients under the age of 70 years there is a loss of 652 pound for the Trust with the present NHS tariffs. (C) 2009 Elsevier Ltd. All rights reserved.