Screw Type for Hip Fracture Correction Effects Cost Outcomes

Hip fractures are a very prevalent (~150,000 annually) and costly (~ six billion dollars annually) problem in the United States.  Because of the high costs associated with the care and recovery from a hip fracture, the type of implants being used are under scrutiny.  Implant type is traditionally determined by the hip fracture.  If the hip fracture is considered “stable” then a screw is attached external to the bone, called an extramedullary sliding hip screw.  These show favorable outcomes. An “unstable” hip fracture is often fixed using an intramedullary nailing, which is a rod that is driven into the middle of the bone to help hold the fragments together. These intramedullary nails are more costly than the sliding screws used for a stable hip fracture correction.  

Unfortunately, hip fractures are not often straight-forward and the determination of whether the fracture is stable or not and which screw to use is left up to the surgeon. The failure of the screws is foremost on the surgeon’s mind because failure means another surgery and more pain for the patient.  Not unexpectedly, then, when surgeons are faced with the decision of which screw to use with a questionably unstable or stable fracture, they choose the intramedullary nailing screw.

Authors of a recent study were interested if this in fact saved money or if it ended up being a higher bill for the patient. They drew from a large sample of hip surgeries and found that results hinged on the fixation failure rate and the implant cost itself. For a stable hip fracture, the obvious choice of using an extramedullary sliding hip screw proved cost effective.  This also proved cost effective for a questionably stable hip fracture for about 70 per cent of the cases.  They concluded that for stable and questionably stable hip fractures a sliding hip screw is the best choice.