This paper reports the cost of outpatient venous thromboembolism (VTE) prophylaxis following 388 injuries of the lower limb requiring immobilisation in our institution, from a total of 7408 new patients presenting between May and November 2011. Prophylaxis was by either self-administered subcutaneous dalteparin (n = 128) or oral dabigatran (n = 260). The mean duration of prophylaxis per patient was 46 days (6 to 168). The total cost (pay and non-pay) for prophylaxis with dalteparin was £107.54 and with dabigatran was £143.99. However, five patients in the dalteparin group required nurse administration (£23 per home visit), increasing the cost of dalteparin to £1142.54 per patient. The annual cost of VTE prophylaxis in a busy trauma clinic treating 12 700 new patients (2010/11), would be £92 526.33 in the context of an income for trauma of £1.82 million, which represents 5.3% of the outpatient tariff.

Outpatient prophylaxis in a busy trauma clinic is achievable and affordable in the context of the clinical and financial risks involved.

Cite this article: Bone Joint J 2013;95-B:673–7.

Aims. This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma. Methods. Data from the Wound Healing in Surgery for Trauma (WHiST) trial, which collected outcomes from 1,547 adult participants using self-completed questionnaires over a six-month period following major trauma, was used as the basis of this empirical investigation. Associations between deep SSI and NHS and personal social services (PSS) costs (£, 2017 to 2018 prices), and between deep SSI and quality-adjusted life years (QALYs), were estimated using descriptive and multivariable analyses. Sensitivity analyses assessed the impact of uncertainty surrounding components of the economic analyses. Results. Compared to participants without deep SSI, those with deep SSI had higher mean adjusted total NHS and PSS costs (adjusted mean difference £1,577 (95% confidence interval (CI) -951 to 4,105); p = 0.222), and lower mean adjusted QALYs (adjusted mean difference -0.015 (95% CI -0.032 to 0.002); p = 0.092) over six months post-injury, but this difference was not statistically significant. The results were robust to the sensitivity analyses performed. Conclusion. This study found worse economic outcomes during the first six months post-injury in participants who experience deep SSI following orthopaedic surgery for major trauma to the lower limb. However, the increase in cost associated with deep SSI was less than previously reported in the orthopaedic trauma literature. Cite this article: Bone Jt Open 2022;3(5):398–403

The South Wales Air ambulance is a charity-funded helicopter service that started functioning on 1 April 2001. There are 10 staff involved in the running of the service, including pilot and paramedics. The territory covered is the South and Mid-Wales regions. The service costs on average £500 per flight and the net cost per year is approximately £750,000. A retrospective study was performed to evaluate the extent and appropriateness of the air-ambulance call-outs over a 12-month period. The guidelines for call-out are based on medical and non-medical criteria. During this period the helicopter made 315 sorties. On 159 occasions the helicopter was stood down once airborne or following landing at the scene. £80,000 has been spent on non-patient -carrying call-outs. Of the 156 patient-carrying sorties 70% were transferred to Mor-riston Hospital, Swansea. 67% of these patients were categorised as trauma patients. Transfer distance averaged just 15 miles (range 2.6-41.2 miles). The majority of trauma cases were categorised as spinal soft tissue injuries or soft tissue injuries. 52% of patients were discharged by A& E staff without requiring orthopaedic assessment. 59% of trauma transfers were deemed to be inappropriate for helicopter transfer by the senior author. Our study concludes that the air-ambulance is used inappropriately in at least 50% of the call-outs. The call-out criteria require amending and should place more emphasis on pick-up location rather than the nature of the casualty. It is not used cost effectively and is not always clinically effective

The June 2023 Wrist & Hand Roundup³⁶⁰ looks at: Residual flexion deformity after scaphoid nonunion surgery: a seven-year follow-up study; The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders; Bite injuries to the hand and forearm: analysis of hospital stay, treatment, and costs; Outcomes of acute perilunate injuries - a systematic review; Abnormal MRI signal intensity of the triangular fibrocartilage complex in asymptomatic wrists; Patient comprehension of operative instructions with a paper handout versus a video: a prospective, randomized controlled trial; Can common hand surgeries be undertaken in the office setting?; The effect of corticosteroid injections on postoperative infections in trigger finger release.

Aims

This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening.

Aims

This study describes the variation in the annual volumes of revision hip arthroplasty (RHA) undertaken by consultant surgeons nationally, and the rate of accrual of RHA and corresponding primary hip arthroplasty (PHA) volume for new consultants entering practice.

Aims. The aim of this study was to estimate economic outcomes associated with deep surgical site infection (SSI) in patients with an open fracture of the lower limb. Patients and Methods. A total of 460 patients were recruited from 24 specialist trauma hospitals in the United Kingdom Major Trauma Network. Preference-based health-related quality-of-life outcomes, assessed using the EuroQol EQ-5D-3L and the 6-Item Short-Form Health Survey questionnaire (SF-6D), and economic costs (£, 2014/2015 prices) were measured using participant-completed questionnaires over the 12 months following injury. Descriptive statistics and multivariate regression analysis were used to explore the relationship between deep SSI and health utility scores, quality-adjusted life-years (QALYs), and health and personal social service (PSS) costs. Results. Deep SSI was associated with lower EQ-5D-3L derived QALYs (adjusted mean difference -0.102, 95% confidence interval (CI) -0.202 to 0.001, p = 0.047) and increased health and social care costs (adjusted mean difference £1950; 95% CI £1383 to £5285, p = 0.250) versus patients without deep SSI over the 12 months following injury. Conclusion. Deep SSI may lead to significantly impaired health-related quality of life and increased economic costs. Our economic estimates can be used to inform clinical and budgetary service planning and can act as reference data for future economic evaluations of preventive or treatment interventions. Cite this article: Bone Joint J 2018;100-B:1506–10

Work-related musculoskeletal disorders are a persistent and expensive health challenge in all industrial countries including Switzerland. A recent European survey indicates that, among the working population, the three most common work health problems reported are: back pain (30%, increasing), stress (28%), muscular pain in arms or in legs (25%). A relatively small group of patients causes relatively high health services costs and long absenteeism from work and furthermore show a high risk to loose workability. Significant progresses have been made these last years in the understanding of the disorder occurrence and chronitisation. Despite of this, the management and successful rehabilitation of MSD suffering workers is still difficult. Recent reviews recommend an intervention strategy based on the bio-psycho-social model. Work hardening and work rehabilitation programs seek to achieve a balance between the physical and mental demands of the job and the individual’s abilities. In a pilot project, we developed and tested the needed instruments and protocols for a multi-disciplinary intervention strategy that takes both aspects into account. This involves the application of clinical and occupation medical skills (rheumatology, occupational medicine, work psychology, ergonomics). Aim: The goal of this controlled, blind, case control study is to compare the effectiveness of the multidisciplinary intervention strategy versus the standard treatment. The two methods will be compared with regard to patients’ ability to return to work. The multidisciplinary intervention strategy consists of. work hardening, cognitive training, and psychosocial counseling directly related to the person’s real work conditions and demands, and. job analysis and, if necessary, modification of work conditions. Patients were recruited for participation in the two groups (120 patients in the intervention group and 120 patients in the control group) in collaboration with companies that have a work absence management system. Two research teams – with members from two university centers (Orthopedic Hospital, Lausanne;University Hospital Zurich) and from the two Swiss institutes working in the area of work and health (Center for Organizational and Occupational Sciences (ZOA), Swiss Federal Institute of Technology; Institut universitaire romand de Santé au Travail (IST), University of Lausanne), will conduct the case control study jointly. In addition, a research team at the University of Neuchâtel will conduct a cost-benefit analysis of the multidisciplinary and the standard treatment. Significance: The whole study would produce new strategies for the management of MSD and workplace rehabilitation as well as guidelines for both authorities and companies. Its potential impact in terms of risk and cost reduction for companies and the society is important

Aims

To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture.

The aim of this study was to assess the effectiveness, as well as cost-effectiveness, of combined manipulative therapy, stabilizing exercises, specialist consultation, and patient education (combination treatment) compared with that from specialist consultation and patient education alone (consultation) for chronic low back pain (CLBP). Secondary objectives were to examine the predictive factors for one-year unfavorable outcome of CLBP and psychosocial differences as determinants for recovery from CLBP following the combination treatment or specialist consultation alone. Additionally, the aim was to assess the changes in physical activity between groups at one year and changes in functional variables between the groups at five months. Of 204 CLBP patients, 102 were randomized to a combination group and 102 to a consultation-alone group. All patients were clinically examined, informed about back pain, and encouraged to stay active and exercise according to specific instructions based on clinical evaluation. Treatment in the combination group included four sessions both of manipulative therapy and of stabilizing exercises aimed at correcting motor control of the trunk. Subjective pain, disability, health-related quality of life, physical activity, coping strategies, satisfaction with care, days of sick leave, consumption of health services, and costs were assessed by several questionnaires. For predictive analysis of treatment outcome, sociodemographic characteristics, work ability, and psychological variables were evaluated and functional assessments performed. Significant improvement occurred in both groups on every self-rated outcome measurement. Within two years, the combination group showed only slightly more significant reduction on the Visual analogue scale (VAS) and clearly greater patient satisfaction than in the consultation group. Specialist consultation alone was more cost-effective in view of both health care use and work absenteeism, and led to an increase in health-related quality of life equal to that from the combination treatment. Patients in the consultation group also tended to increase their intensity of physical exercise, other activities, and their active time more than did those in the combination group. Psychometric factors, longer previous sick-leave days, and a low to moderate level of pain intensity proved strongly to predict unfavorable treatment outcome. The Multidimensional Pain Inventory (MPI) was used to identify three patient subgroups to determine treatment outcome. These subgroups were active copers (AC), interpersonally distressed (ID), and dysfunctional (DYS) patients. They were distinguished by level of pain severity, affective distress, life control, and of activity. In this study, MPI patient profile clustering determined the slightly greater effectiveness of the combination therapy than of the consultation alone. The effectiveness of combination therapy was due to the large changes among the dysfunctional (DYS) patients, who gained an extra advantage from combination therapy both in perceived disability (ODI) and pain intensity (VAS). The advantage for ODI disappeared at the two-year follow-up due to the improving trend among the DYS patients in the consultation group. The advantage for pain intensity remained throughout the follow-up. For the AC and ID patients, the consultation alone was as effective as the combination treatment. Both the specialist consultation group and the combination treatment group showed unexpectedly good improvement regarding pain, disability, and health-related quality of life. The combination treatment including manipulative therapy, stabilizing exercises, and specialist consultation did not clearly enhance the effect gained by the specialist consultation alone. A subgroup of dysfunctional patients appeared, however, to be more sensitive to the combination treatment, needing more repetition and fortification of the information with hands-on therapy and exercises

Aims

The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb.

Aims

To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery.

Aims

The aims of this study were to compare the use of resources, costs, and quality of life outcomes associated with subacromial decompression, arthroscopy only (placebo surgery), and no treatment for subacromial pain in the United Kingdom National Health Service (NHS), and to estimate their cost-effectiveness.

A retrospective study was performed in 100 children aged between two and 16 years, with a dorsally angulated stable fracture of the distal radius or forearm, who were treated with manipulation in the emergency department (ED) using intranasal diamorphine and 50% oxygen and nitrous oxide. Pre- and post-manipulation radiographs, the final radiographs and the clinical notes were reviewed. A successful reduction was achieved in 90 fractures (90%) and only three children (3%) required remanipulation and Kirschner wire fixation or internal fixation.

The use of Entonox and intranasal diamorphine is safe and effective for the closed reduction of a stable paediatric fracture of the distal radius and forearm in the ED.

By facilitating discharge on the same day, there is a substantial cost benefit to families and the NHS and we recommend this method.

Take home message: Simple easily reducible fractures of the distal radius and forearm in children can be successfully and safely treated in the ED using this approach, thus avoiding theatre admission and costly hospital stay.

Cite this article: Bone Joint J 2016;97-B:131–6.

We present an economic evaluation using data from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare the relative cost effectiveness of percutaneous Kirschner wire (K-wire) fixation and volar locking-plate fixation for patients with dorsally-displaced fractures of the distal radius.

The cost effectiveness analysis (cost per quality-adjusted life year; QALY) was derived from a multi-centre, two-arm, parallel group, assessor-blind, randomised controlled trial which took place in 18 trauma centres in the United Kingdom. Data from 460 patients were available for analysis, which includes both a National Health Service cost perspective including costs of surgery, implants and healthcare resource use over a 12-month period after surgery, and a societal perspective, which includes the cost of time off work and the need for additional private care.

There was only a small difference in QALYs gained for patients treated with locking-plate fixation over those treated with K-wires. At a mean additional cost of £714 (95% confidence interval 588 to 865) per patient, locking-plate fixation presented an incremental cost effectiveness ratio (ICER) of £89 322 per QALY within the first 12 months of treatment. Sensitivity analyses were undertaken to assess the ICER of locking-plate fixation compared with K-wires. These were greater than £30 000.

Compared with locking-plate fixation, K-wire fixation is a ‘cost saving’ intervention, with similar health benefits.

Cite this article: Bone Joint J 2015;97-B:1082–9.

Aims

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.

We investigated whether, in the management of stable paediatric fractures of the forearm, flexible casts that can be removed at home are as clinically effective, cost-effective and acceptable to both patient and parent as management using a cast conventionally removed in hospital. A single-centre randomised controlled trial was performed on 317 children with a mean age of 9.3 years (2 to 16). No significant differences were seen in the change in Childhood Health Assessment Questionnaire index score (p = 0.10) or EuroQol 5-Dimensions domain scores between the two groups one week after removal of the cast or the absolute scores at six months. There was a significantly lower overall median treatment cost in the group whose casts were removed at home (£150.88 (sem 1.90) vs £251.62 (sem 2.68); p <  0.001). No difference was seen in satisfaction between the two groups (p = 0.48).

Cite this article: Bone Joint J 2013;95-B:1714–20.