No cost difference between single or dual implants for distal femur fractures in the perioperative period.

PURPOSE: This study uses a value-driven outcome model to assess the cost-effectiveness of single versus dual implants used in the fixation of distal femur fractures (DFF).

METHODS

A retrospective review identified all DFF treated at a level I trauma center between 2013 and 2023. Patients with open fractures, bilateral fractures, multiple injuries, and less than six months of cost-data or follow-up were excluded. DFF were divided into fixation by an intramedullary nail (IMN), lateral plate (LP), or dual construct (DC) including IMN and plate or dual plating. Cost data included all costs, including implant, facility, and operative costs associated with initial surgery and subsequent admissions associated with the injury. Actual cost data were analyzed via an inverse Gaussian regression model.

RESULTS

Of 293 cases, 123 were treated by IMN, 133 by LP, and 37 by DC. There was no demographic, BMI, Charlson Comorbidity Index (CCI), or Injury Severity score (ISS) differences between groups. DC DFF tended to be AO Type C (27%) or periprosthetic fractures (35%) (p < 0.001). DC was 47% more expensive than IMN and 43% more expensive than LP at initial surgery (p < 0.001) and 46% more expensive than IMN and 40% more costly than LP downstream (p < 0.001). However, when controlling for age, BMI, fracture classification, and ISS, there was no difference in total cost across fixation types.

CONCLUSION

The total cost for dual construct fixation of distal femur fractures was similar to intramedullary nailing or lateral plating despite higher initial costs and use in more complex fracture patterns.