What’s the Claim?
In a recent cost study, intramedullary screw fixation for metacarpal and phalangeal fractures didn’t differ much from K-wire fixation, and where there were differences – costs that accrued during follow-up, such as for hand therapy and dressing changes — they slightly favored use of the intramedullary screws. Costs were higher still for techniques involving buried K-wires. Complications and outcomes scores did not differ between the two study groups. The study included both open and closed fractures.
How’s It Stack Up?
Cost studies always raise our antennae because the concept is so important, but the execution of these studies is usually “iffy.” Does cost mean charge? Fees collected? Actual cost to the physician or healthcare system? It can be hard to tell, and it’s hard to tell here, too. Fortunately, for purposes of this exercise, the exact cost here is less important than the idea that the authors really are measuring total resource utilization to a healthcare system, and since the numbers all came from the UK National Health Service, as a surrogate for resource utilization, what they were calling “cost” was robust enough for the purpose. We found no other studies that specifically compared the cost (or resource utilization) of screws to that of K-wires for these indications.