Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails

Aleksey Dvorzhinskiy; David T Zhang; Austin T Fragomen; S Robert Rozbruch

doi:10.5005/jp-journals-10080-1513

Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails

Strategies Trauma Limb Reconstr. 2021 Jan-Apr;16(1):14-19. doi: 10.5005/jp-journals-10080-1513.

Authors

Aleksey Dvorzhinskiy¹, David T Zhang¹, Austin T Fragomen¹, S Robert Rozbruch¹

Affiliation

¹ Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, United States.

Abstract

Aim and objective: Tibial lengthening can be performed by distraction osteogenesis via lengthening and then nailing (LATN) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. Concerns exist still regarding the high upfront cost of the magnetic nail, which serves to limit its use in resource-poor areas and decrease adoption among cost-conscious surgeons. The purpose of this study was to compare the hospital, surgeon, and total cost between LATN and MLN when used for tibial lengthening.

Materials and methods: A retrospective review was performed comparing consecutive tibial lengthening using either LATN (n = 17) or MLN (n = 15). The number of surgical procedures and time to union were compared. Surgeon and hospital payments were used to perform cost analysis after adjusting for inflation using the consumer price index (CPI).

Results: Patients treated with MLN underwent fewer surgeries (3.6 vs 2.8; p < 0.001) but had a longer time to union as compared with patients treated with LATN (19.79 vs 27.84 weeks; p = 0.006). Total costs were similar ($50,345 vs $46,162; p = 0.249) although surgeon fees were lower for MLN as compared with LATN ($6,426 vs $4,428; p < 0.001).

Conclusion: LATN and MLN had similar overall costs in patients undergoing tibial lengthening. MLN was associated with fewer procedures but a longer time to union as compared with LATN.

Clinical significance: Despite an increased upfront cost in MLN, there was no difference in total cost between LATN and MLN when used for tibial lengthening. Thus, in cases where either method is feasible, cost may not be a deciding factor when selecting the appropriate treatment.

How to cite this article: Dvorzhinskiy A, Zhang DT, Fragomen AT, et al. Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails. Strategies Trauma Limb Reconstr 2021;16(1):14-19.

Keywords: Bone lengthening; Circular external fixation; Distraction osteogenesis; Internal fixation combined with external ring fixation; Internal lengthening nail; Intramedullary lengthening; Leg length discrepancy; Lengthening nail; Motorized implantable nail; Tibia.