Se. Nork et Sa. Hoffinger, SKELETAL TRACTION VERSUS EXTERNAL FIXATION FOR PEDIATRIC FEMORAL-SHAFT FRACTURES - A COMPARISON OF HOSPITAL COSTS AND CHARGES, Journal of orthopaedic trauma, 12(8), 1998, pp. 563-568
Objectives: To compare the hospital costs, charges, and reimbursement
for treatment of pediatric femur fractures by two treatment methods: e
xternal fixation and 90-90 tr action with spica casting. Design: Retro
spective clinical review. Setting: Department of Orthopaedic Surgery,
Children's Hospital Oakland, regional pediatric trauma center. Patient
s: Twenty-nine consecutive patients between the ages of five and ten w
ith a fracture of the femoral shaft were treated by one of two methods
: external fixation (sixteen patients) or 90-90 skeletal traction foll
owed by spica casting (thirteen patients). Intervention: External fixa
tion or 90-90 traction followed by spica casting. Main Outcome Measure
: Hospital billing data including costs, charges, reimbursement for th
e initial inpatient hospitalization, and outpatient financial data unt
il fracture union and cessation of treatment. Results: There was no di
fference in age, total treatment time, mechanism of injury, or number
of associated injuries between the two groups. The average charge for
treatment with skeletal traction and spica casting was $32,094 per pat
ient versus $21,339 for external fixation (p < 0.001). The average cos
t for treatment with traction and spica casting was $22,396 per patien
t versus $11,520 for external fixation (p < 0.001); reimbursement was
$30,846 and $7,490, respectively (p < 0.001). The number of days in th
e hospital was larger for the traction group than for the external Fix
ation group (22.3 days versus 4.7 days, p < 0.0001). Conclusions: Exte
rnal fixation of pediatric femoral shaft fractures results in decrease
d hospital costs and length of hospitalization, but produces significa
ntly less income for the hospital when compared with skeletal traction
followed by spica casting.