Cost Assessment of Plating Versus Tension Band Wiring Constructs for Treating Mayo Type 2A Olecranon Fractures

Abstract

Purpose: Tension band wiring (TBW) or plating may be used for fixation with similar clinical outcomes for adults with displaced Mayo 2A olecranon fractures. The primary hypothesis is that total direct costs (TDCs) for surgery are lower for TBW than plating. Our secondary hypothesis is that combined surgical TDCs are lower for TBW even with a 100% rate of subsequent tension band hardware removal and a 0% rate of plate removal.

Methods: Patients who underwent TBW or plating of an isolated unilateral Mayo 2A olecranon fracture between July 2011 and January 2020 at a single academic medical center were identified. Then, TDC for each surgery on plate fixation, TBW, and hardware removal was obtained and converted to 2020 US dollars using information technology cost tools provided by our institution. Finally, relative TDCs were compared between plate fixation and TBW groups using univariate and multivariable generalized estimating equations with log-link.

Results: Of the 97 included patients, the mean age was 50 ± 21 years, and 48% were female. Tension band wiring and plate fixation were performed on 18% (17/97) and 82% (80/97) of male and female patients, respectively. Demographics were similar between groups, although the finding that plate fixation cost 2.6 times that of TBW within the index surgery was significant in the multivariable model, independent of potential confounders (coefficient 2.55, 95% confidence interval: 2.09-3.10). Additionally, mean TDC remained significantly greater for plate fixation even under the hypothetical situation where 100% TBW were removed, and the plate removal rate was 0% (cost difference 181%).

Conclusions: Using TBW relative to plate fixation may improve the cost of care for operative Mayo 2A olecranon fractures. Furthermore, this finding was robust to the rate of hardware removal.

Type of study/level of evidence: Economic and Decision Analyses III.

Keywords: Olecranon fracture; plate fixation; tension band wiring; total direct cost.

Figure 1:

Total Direct Costs of Plate and Tension Band Wiring Fixation in Two Scenarios Box and whisker plots illustrating the total direct costs of the two surgical fixation methods in two scenarios. A) Initial implantation of plate fixation and TBW and B) a hypothetical case where 0% of plates were removed and 100% of tension bands were removed. In both comparisons, TBW median TDC were standardized as 1, although the standardized values are equal, they represent different actual dollar amounts. *Significantly different TDC relative to paired TBW subgroup (p < 0.05). TDC: total direct cost. TBW: tension band wiring.