Intramedullary nailing versus minimally invasive plating in the treatment of distal tibial extra-articular fractures: Comparison of cost analysis in Turkey

BACKGROUND: Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey. METHODS: The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients’ clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital’s billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient’s returns to work were also recorded. RESULTS: 118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients’ age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p=

Tibia distal eklem dışı kırıklarının tedavisinde kanal içi çivileme ve minimal invaziv plaklama: Türkiye’de maliyet analizinin karşılaştırılması

AMAÇ: Minimal invaziv perkütan plak osteosentezi (MIPO) ve kanal içi çivileme (IMN) distal tibia eklem dışı kırıkları için en sık kullanılan iki yöntemdir; ancak ideal tedavi halen tartışmalıdır. Bu çalışmanın amacı, distal tibia eklem dışı kırıklarının tedavisinde MIPO ve IMN’yi Türkiye’deki sağlık sigortası kayıtlarına göre maliyet analizi açısından karşılaştırmaktır. GEREÇ VE YÖNTEM: Bu geriye dönük çalışmada 2013–2018 yılları arasında distal tibia eklem dışı kırıkları tedavisi için MIPO veya IMN uygulanan hastaların verileri incelendi. Hastaların klinik verileri ve ilk yatıştan işe dönüşe kadar hastaneye yatış dahil toplam masraflar ve tüm ayakta tedavi kontrolleri hastanenin faturalandırma bölümünde gözden geçirildi. Sosyal Güvenlik Kurumu (SGK) tarafından işe dönene kadar hastaya aylık ödenen toplam para miktarı da kaydedildi. BULGULAR: Çalışmaya yaş ortalaması 37.2±13.4 olan 118 ardışık hasta (35 kadın–83 erkek) katıldı. İntramedüller çivileme (IMN) grubu yaş ortalaması 36.7±12.8 yıl olan 57 hastadan, MIPO grubu ise yaş ortalaması 37.8±13.6 yıl olan 61 hastadan oluşmaktaydı. Çalışma grupları arasında hastaların yaşı, cinsiyeti, kırık sınıflamaları (AO/OTA sınıflandırması), yumuşak doku yaralanması (Tscherne sınıflandırması), tip 1 açık kırık varlığı ve eşlik eden fibula kırığı varlığı açısından anlamlı fark gözlenmemiştir. Ameliyat öncesi hastanede kalış süresi açısından iki grup arasında istatistiksel fark yoktu (p=0.713). Ancak ortalama hastanede kalış süresi MIPO grubunda anlamlı olarak daha yüksekti (p=

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