Value driven outcome (VDO) assessment for the treatment of olecranon fractures

Abstract

Purpose: Controversy remains about the ideal construct for certain olecranon fractures. The purpose of this study was to compare cost-effectiveness with the value driven outcomes tool between fixation strategies of olecranon fractures.

Methods: All surgically treated isolated proximal ulna fractures (CPT code 24,685) at a level 1 trauma center from 2013 to 2023 were retrospectively reviewed. Patients with concomitant radial/ulnar shaft fractures and ligamentous elbow injuries requiring repair were excluded. Demographics, outcomes, initial, downstream (costs secondary to index surgery), and combined cost were compared between plate andintramedullary (IM) screw constructs. Costs included charges to the hospital from facility, implant, supply, pharmacy, imaging, and other service use.

Results: 102 patients with average age of 51 were included: 84 olecranon-specific plates and18 IM screws. Average follow-up was 14.62 ± 16.79 months. There were differences in CCI (p = 0.006). Plate initial and combined cost was significantly greater than an IM screw (1.26x, p = 0.007; 1.49x, p = 0.009, respectively). Using IM screws for reference and controlling for demographics and fracture patterns, treatment with a plate was more expensive at downstream and combined total cost (56.28x, p = 0.04;76.73x, p = 0.03, respectively).

Conclusion: Olecranon plate fixation is associated with increased downstream and overall cost to the healthcare system. When indicated, other forms of fixation should be considered due to lower costs while still maintaining satisfactory outcomes.

Keywords: Intramedullary screw; Olecranon fracture; Plate fixation; Total direct cost; Value driven outcomes.