SKELETAL TRACTION VERSUS EXTERNAL FIXATION FOR PEDIATRIC FEMORAL-SHAFT FRACTURES - A COMPARISON OF HOSPITAL COSTS AND CHARGES

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.