Abstract:
BACKGROUND:To determine whether the cost of nonoperative treatment, including those who require delayed operative treatment, is less than those receiving initial operative management. METHODS:We identified 4 recent randomized controlled trials comparing operative and nonoperative treatment of displaced midshaft clavicle fractures in adults with a minimum of 1-year follow-up. A decision tree was then created from these data using reoperation for those treated with surgery or delayed operative treatment of those treated nonoperatively as end points. Actual costs estimated from 2013 Medicare reimbursement rates were applied and adjusted to better reflect private insurance rates. We then performed a 2-way sensitivity analysis to test the stability of our model. RESULTS:Based on our decision tree, the expected costs for operative and nonoperative treatment were $14,763.21 and $3112.65, respectively, producing a cost savings of $11,650.56 with nonoperative treatment. After application of a 2-way sensitivity analysis, our model remains valid until delayed operative treatment for nonoperative patients approaches 95% and reoperation after initial operative management falls below 15%. CONCLUSIONS: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. LEVEL OF EVIDENCE:Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Walton B,Meijer K,Melancon K,Hartman Mdoi
10.1097/BOT.0000000000000225subject
Has Abstractpub_date
2015-04-01 00:00:00pages
173-80issue
4eissn
0890-5339issn
1531-2291journal_volume
29pub_type
杂志文章,meta分析,评审abstract:OBJECTIVES:To assess whether plate bending at a hole significantly changes the biomechanical properties of a locked screw. METHODS:Coronal plane bends of 5-, 15-, or 45-degree angles were placed in 3.5-mm locking compression plates with the apex at a locking hole. An additional 45-degree angle test group was created i...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182a73a77
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:To determine the current published patterns of computed tomography (CT) use postoperatively in peri-articular fractures and identify those populations whereby postoperative CT changes management or results in better clinical outcomes. DATA SOURCES:Systematic review of MEDLINE and Cochrane using a combinatio...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,meta分析,多中心研究
doi:10.1097/BOT.0000000000000660
更新日期:2017-01-01 00:00:00
abstract::Road traffic accidents are a leading cause of global mortality. In March 2010, the United Nations General Assembly and the World Health Organization (WHO) officially proclaimed 2011-2020 as the "Decade of Action for Road Safety." Researchers must focus on vulnerable road users and low- and middle-income countries (LMI...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000103
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVE:Syndesmotic instability may coexist with unstable Weber B supination-external rotation (SE) lateral malleolar fractures. Current recommendations suggest that Weber B injuries should not have associated syndesmotic instability after open reduction and internal fixation of the lateral malleolus. The purpose of ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318157a63a
更新日期:2007-10-01 00:00:00
abstract::Severe open foot and ankle injuries are still a challenge for the orthopaedic surgeon. Their treatment is even more difficult in third world countries and in war settings where high-energy trauma with severe soft tissue damage is more frequent. Lack of equipment, poor resources and hygiene, and different cultural syst...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181d4be0f
更新日期:2011-03-01 00:00:00
abstract:PURPOSE:The purpose of this OTA-approved pilot study was to compare the clinical and functional outcomes of the knee joint after infrapatellar (IP) versus suprapatellar (SP) tibial nail insertion. DESIGN:Prospective, randomized. SETTING:Level I trauma center. METHODS:After institutional review board approval, skelet...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,随机对照试验
doi:10.1097/BOT.0000000000000499
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVES:In the distal femur, locked plating is efficacious when coronal fractures preclude the use of a conventional fixed-angle device. However, minimal comparative data exist for supracondylar fracture patterns, which could be treated with other devices. The purpose of this study was to compare the 95-degree angle...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318234d460
更新日期:2012-06-01 00:00:00
abstract::In patients who are candidates for a total knee arthroplasty and suffer a periarticular fracture of the femur, the arthroplasty may be performed after bony union of the fracture or immediately, in conjunction with the fracture repair. Herein we present the case of a sixty-year-old female with rheumatoid arthritis and ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199906000-00014
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVES:The stacked hexapod bone transport technique is an effective treatment for infected tibial nonunions with bone loss. The purpose of this study was to evaluate the patients' risk factors and timing for requiring adjunctive stabilization. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PAT...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000840
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:Low-intensity pulsed ultrasound (LIPUS) provides noninvasive therapeutic treatment to accelerate fracture repair and distraction osteogenesis. However, most studies concerning the influence of LIPUS on bone metabolism have been conducted in vivo systems using osteoblastic cells. Therefore, details of the dire...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000489982.40329.52
更新日期:2016-08-01 00:00:00
abstract::Immediate (within 24 h) open reduction and internal fixation of 103 open fractures of one or both bones of the forearm was accomplished in 69 patients between 1980 and 1989. Fifty-four of the 103 patients were reevaluated 1 to 7 years postinjury (average 2.5 years) to determine the efficacy of this treatment. Forty-fi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:
更新日期:1992-01-01 00:00:00
abstract::Two unusual cases of symptomatic partial rupture of the extensor carpi ulnaris tendon associated with ulnar-styloid nonunion are described. Intraoperative findings suggested that the jagged surface of the distal ulna was the cause of flaying. In one case, debridement of the frayed extensor carpi ulnaris tendon and fix...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200210000-00011
更新日期:2002-10-01 00:00:00
abstract::Understanding complex acetabular fractures is difficult and may require three-dimensional reformatted computed tomographic (CT) images. This paper evaluates a technique, digital rotational imaging (DRI), that displays multiple oblique images of the pelvis and acetabulum. When viewed statically, DRI provides optimal il...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199801000-00011
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVES:To investigate the incidence of concomitant posterior malleolar fractures (PMFs) in operative, distal-third, spiral tibia fractures. DESIGN:Prospective protocol with retrospective review of data. SETTING:Single, Level 1 trauma center. PATIENTS/PARTICIPANTS:One hundred ninety-three consecutive, skeletally ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001307
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVES:To compare the strength of fixation of percutaneous screw versus plate/screw fixation in a paired cadaver model of OTA 41-B3 (Schatzker type II) split-depression fractures of the lateral tibial plateau. METHODS:Six matched pairs of cadaveric knees were acquired. An OTA 41-B3 (Schatzker type II) split-depres...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001177
更新日期:2018-07-01 00:00:00
abstract::Fracture compression can be achieved in many ways intraoperatively using either screws in compression plates, compression devices, or using intramedullary nails. The use of locked intramedullary nails combines the advantages of indirect fracture fixation and compression with minimal soft tissue disruption. This articl...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0b013e31819f2779
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVES:Hand dominance has been reported to be an important factor affecting outcomes after upper extremity trauma but remains unstudied after hemiarthroplasty for fracture. This study determined whether dominance affected outcomes after hemiarthroplasty for proximal humerus fractures. DESIGN:Retrospective cohort s...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000294
更新日期:2015-08-01 00:00:00
abstract::Minifragment implants provide several advantages for the stabilization of distal humerus fractures. Compared with small fragment implants, minifragment implants may provide enhanced fracture fixation because a greater number of screws can be placed into the distal fragments. In addition, minifragment plates are easier...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000157908.45939.d7
更新日期:2005-08-01 00:00:00
abstract::In physiologically young patients with displaced femoral neck fractures, surgical treatment is aimed at achieving fracture union while preserving native hip anatomy and biomechanics. The intracapsular environment, tenuous vascular supply, and unfavorable hip biomechanics contribute to the high complication rates seen ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000001368
更新日期:2019-01-01 00:00:00
abstract::Long-bone deformity may be significantly symptomatic. A uniplanar corrective osteotomy uses a single cut to correct coronal, sagittal, and axial plane deformity simultaneously. Careful preoperative planning is required in addition to a comprehensive understanding of the magnitude and plane of the true deformity of the...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001519
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVES:External fixator pins are thought to have improved pullout strength if inserted into both cortices and if pilot holes are drilled. We tested these hypotheses and investigated effects of osteoporosis and pin location on pin pullout strength. METHODS:Self-drilling external fixator pins were inserted using 4 t...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182511ed7
更新日期:2013-02-01 00:00:00
abstract::The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding. Children with multiple system injuries, a head injury, and/or multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a pathological fracture ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199212000-00011
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:Acceptable amounts of malrotation after CRPP for pediatric supracondylar humerus fracture (SCHFx) have yet to be defined. This is an attempt to correlate radiographic parameters of a malrotated SCHFx with degrees of rotational malalignment to assist intraoperative assessment of reduction. METHODS:3D models ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001735
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the clinical use of the Partridge osteosynthesis in periprosthetic femoral fractures. DESIGN AND SETTING:Prospective nonrandomized clinical study. PATIENTS:Over a ten-year period, 222 patients presenting with femoral fractures near the tip of a hip prosthesis were treated with the Partridge syst...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/00005131-200101000-00011
更新日期:2001-01-01 00:00:00
abstract::Ipsilateral femoral shaft and tibial plateau fractures, termed a "floating knee" are rare and challenging injuries. There is limited literature guiding the operative technique and the outcomes associated with these injuries. The author's preferred technique is early intramedullary of the femoral shaft fracture with kn...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001944
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVES:To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture. DESIGN:Prospective cohort study. SETTING:A secondary teaching hospital. PARTICIPANTS:We enrolled...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000532
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVES:To report the safety and clinical outcomes of placing current magnetic resonance imaging (MRI) components inside and outside the MRI bore during MRIs. DESIGN:Retrospective case series. SETTING:Four trauma centers (3 Level I and 1 Level II), from January 2005 to January 2015. PATIENTS:All patients who had ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,多中心研究
doi:10.1097/BOT.0000000000000954
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVES:To document the high failure rate of a specific implant: the Synthes Variable Angle (VA) Locking Distal Femur Plate. DESIGN:Retrospective. SETTING:Urban University Level I Trauma Center. PATIENT/PARTICIPANTS:All distal femur fractures (OTA/AO 33-A, B, C) treated from March 2011 through August 2013 were re...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000391
更新日期:2016-01-01 00:00:00
abstract::Difficulty in maintaining the reduction of displaced radial fractures has prompted the use of numerous techniques to address this problem. The purpose of this study was to determine if four or five 0.045-in Kirschner pins when placed percutaneously through the ulna into the radius could maintain the reduction of this ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-198906000-00004
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVES:To report on the radiographic and clinical outcome of symphyseal plating techniques, with specific attention to the incidence of implant failure, reoperation secondary to implant complication, and ability to maintain reduction of the pelvic ring. DESIGN:Retrospective chart and radiographic review. SETTING:...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31817e49ee
更新日期:2008-07-01 00:00:00