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Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 70 - 70
1 Dec 2015
Olesen U Lykke-Meyer L Bonde C Eckardt H Singh U Mcnally M
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Open tibial fractures have a high infection risk making treatment difficult and expensive. Delayed skin closure (beyond 7 days) has been shown to increase the infection rate in several studies (1).

We aim to calculate the cost of infection as a complication of open tibial fractures and to determine the effect of delayed skin closure on this cost.

We retrospectively reviewed all records of patients treated with a free flap in our institution for an open tibial fracture from 2002 to 2013.

We calculated direct costs of treatment by the DRG-values (2014 figures), based on length of stay (LOS), diagnosis, orthopaedic and plastic surgical procedures and the corresponding reimbursement.

The primary goal was to establish the extra cost incurred by an infection, compared to treating an uninfected open tibial fracture. The cost efficiency saving of early soft tissue cover was also investigated.

We analysed 45 injuries in 44 patients. All patients were treated with debridement, stabilization, prophylactic antibiotics and free flap cover. Infection increased the mean total LOS in hospital from 28.0 to 63.8 days. The presence of an infection increased the cost of treatment from a mean of €49.301 for uninfected fractures compared to a mean of €67.958 for infected fractures.

Achieving skin cover within 7 days of injury decreased the infection rate from 60% to 27% (total series rate 48%). The provision of early soft tissue cover (before 7 days) for all patients would have saved an average of €18.658 per patient.

The development of an infection after a severe open tibial fracture greatly increases the cost of treatment. Early soft tissue cover is one aspect of care which has been shown to improve clinical outcomes. This study confirms that it will also reduce the cost of treating these complex fractures – underscoring the need for rapid referral and an ortho-plastic setup to handle them.

We have only calculated the direct costs of treatment. Infected fractures will also consume extra costs in rehabilitation and absenteeism from later infection recurrence and non-union. Therefore, our estimate of the potential saving is likely to be conservative.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 52 - 52
1 Mar 2006
Engfred K Singh U Mejdahl S Petersen V Lemser T
Full Access

Introduction: Analysis of the clinical outcome and survivalrate of the Harris/Galante 1 cup combined with two different stems.

Material and methods: Retrospective study on patients who underwent surgery in the years 1986–1989. There was a total of 544 patients with 593 total hip replacements (THR), 264 patients died prior to investigation (285 THR).

All deceased were checked in the danish patient registration system for revision. 113 patients with 128 THR were operated with the Spotorno CLS stem, and 431 patients with 465 THR with the Mller straight stem.

270 patients with 297 THR were assessed radiographically and according to a modified Harris Hip Score (ROM was not used). Some were due to age or other illnes not able to attend the examination. If possible they were interviewed by telephone.

The median age was 69,4 (range 18,3 – 88,1) for all, for the Spotorno CLS group 55 years (range 18–72) and for the Mller group 72 years (41–88). Male/female ratio: 0,56. Average follow-up was 13 years (range 9,1 -15.1).

The primary diagnosis was osteoarthritis 538 hips, RA 10, fracture sequelae 15, congenital dislocation 14, others contributed with 16 hips.

The survival rates were calculated using the Kaplan-Meier method.

Results: 35 patients have had a revision: 21 because of aseptic loosening, 4 because of femoral fracture, 5 because of dislocation, and 1 because of infection. 4 liners were revised because of polyethylene wear. Only one was in the Mueller group, 3 in the CLS group.

After 13 years the survival rate for the cups was 96.8% including reoperations for polyethylene wear, for the femoral Mueller stem 90.7% and for Spotorno CLS 96.1 %

Conclusion: The Harris/Galante cup and Spotorno show excellent survival after 13 years, and for the Mueller stem the survival rate is comparable to others. The relative high rate of polyethylene wear in the CLS group we believe to be a consequense of the younger patients more active lifestyle.