Article Text
Abstract
Introduction Femoral shaft fractures carry considerable morbidity and are increasingly common in less economically developed countries (LEDCs). Treatment options include traction and intramedullary (IM) nailing but in a limited-resource environment; cost-effectiveness is fundamental to policy development.
The objective herein was to evaluate the cost-effectiveness of moving from traction to IM nailing for femoral shaft fractures, in adults, in LEDCs. Incorporating a systematic review of complications and functional outcomes and a cost-minimization analysis.
Methods PubMed, EMBASE, Africa Journals Online and the Cochrane Library were searched from inception using the terms: femur* AND fracture AND traction AND (sign OR nail* OR intramedullary) AND (cost-effectiveness OR cost* OR outcome OR function) NOT paed* NOT child* NOT elastic NOT neck NOT intertrochanteric NOT periprosthetic (where asterisks indicate an unlimited truncation strategy). Abstracts were reviewed for all titles returned and full texts obtained as indicated. References of all relevant papers were also examined for further studies.
Results IM nailing has been successfully used in several institutions and reported infection, union and reoperation rates are encouraging, although no randomised control trials were identified. Three studies assessed the cost aspect and all found IM nailing to be the cheaper strategy.
Conclusion To date, the improved complication profile and reduced cost of treatment suggest that IM nailing is more cost-effective than traction. Evidence, however, is limited and the necessity for appropriate training and audit with the introduction of new techniques must be emphasised.
- Health economics < Health policies and all other topics
- Orthopedic surgery
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Footnotes
Contributors RJP designed the study with the assistance of KJ (with some refining from GP). RJP generated the literature search. RJP and GP undertook the review process. RJP largely compiled the final article with editorial contributions from GP and KJ. All authors reviewed the final manuscript and revisions. Librarians Lisa Toyne and Barbara Pierce helped in accessing some of the more difficult to locate papers.
Competing interests GP works in hospitals that uses the SIGN nails but none of the authors directly benefit from their use.
Provenance and peer review Not commissioned; externally peer reviewed.