Suneel Bhat - Rothman Institute at the Thomas Jefferson University
Frederick Liss - Thomas Jefferson University Hospital
Pedro Beredjiklian - Rothman Institute Jefferson Medical College

Background: There are a number of different implant choices for surgical treatment of distal radius fractures, oftendetermined by surgeon preference or availability. Although no one volar plate demonstrates superior outcomes, thereare significant cost differences absorbed by hospitals and surgical centers. This purpose of this study is to characterizethe economic implications of implant selection in the surgical management of distal radius fractures.Methods: A retrospective review of billing records at a mid-size community surgicenter was conducted for CPT codes25607, 25608, and 25609 between 1/1/2014 and 6/1/2014, and associated implant costs and facility reimbursementswere collected. A unique stochastic simulation model was developed from derived probabilities, reimbursements, andcosts, and analyzed by Monte Carlo simulation.Results: Reimbursement to the facility for distal radius ORIF cases ranged from $1,102.20 to $7,393.86, with anaverage of $3,824.56. Per case operating costs to the facility ranged from $1,250 to $7,270, with an average of$2,817.42. In the US, variations in implant cost 25% above or below the mean translates to annual operating profitsrealized by facilities ranging from a loss of $57,047,720 to profits of $55,189,729. On average, per case operatingcosts for distal radius fractures need to be less than $2956 fo r facilities to realize a per case profit.Conclusion: Value based purchasing is by necessity becoming integrated into clinical decision making byorthopaedic surgeons. Variations of 25% around the mean per case operating cost can vary facility operating marginsby $112,237,450 annually. Arming the orthopaedic surgeon with the realities of the cost of implant selection in theoperative management of distal radius fractures will lead to better value based decision making, substantial costsavings to the US hospital system, and ultimately payers and patients.Level of evidence: II

Cost, Distal radius fracture, Economic analysis, Implants, Wrist