Narrow Results

Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context.

Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics.

Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS – a differential of AUD 1,973.35.

Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures.

Level of Evidence: Level III (Cost Utility)

Metacarpal fractures are a common injury in the hand. When surgical intervention is indicated, there are multiple approaches and techniques of fixation. Intramedullary fixation has become an increasingly versatile method of fixation. The limited dissection needed for its insertion, rotational stability provided by the isthmic fit and lack of requisite hardware removal are improvements over conventional K-wire or plate fixation techniques. Multiple outcome studies have confirmed its safety and effectiveness. In this technical note, we provide some tips that can help surgeons considering intramedullary headless screw fixation of metacarpal fractures.

Level of Evidence: Level V (Therapeutic)