Volar locking plates versus Kirschner wires for distal radial fractures--a cost analysis study

Injury. 2009 Dec;40(12):1279-81. doi: 10.1016/j.injury.2009.02.018. Epub 2009 Jun 13.


Background: There is an increasing trend for managing dorsally angulated distal radial fractures with locked volar plate fixation in fractures that may have previously been managed with percutaneous Kirschner wire (K-wire) fixation. There has been no prospective randomised trial comparing locked volar plate fixation with percutaneous K-wire fixation. In the absence of data guiding management with regard to clinical effectiveness, we have examined the cost of each technique.

Methods: Patients' details were collected retrospectively between June 2007 and June 2008. Ten consecutive patients who underwent percutaneous K-wire fixation for a distal radius fracture and the 10 who were treated by locked volar plate fixation were identified and their hospital notes retrieved. All patients had a closed extra-articular distal radial fracture with dorsal angulation. The duration and type of operation, including number of wires or screws used, were recorded.

Results: The mean age of the patients was 54 years for the locking plate group and 34 years for the percutaneous K-wire group. The mean time taken to perform percutaneous K-wire fixation with an average of two K-wires was 56 min. The mean time for applying a volar locked plate was 121 min. The cost of a pack of 10 K-wires was 3 pounds. The total cost of a standard volar locking plate and screws used was 787 pounds.

Discussion: In the absence of research comparing clinical end points, cost must play a major factor in determining the type of operation offered. A 56-min operation to percutaneously fix a distal radial fracture with K-wires costs 662 pounds. This compares to a cost of 2212 pounds for a 121-min locked volar plate fixation. There is a calculated difference of 1549 pounds and 65 min.

Conclusion: With use of a locked volar plate for patients under the age of 70 years there is a loss of 652 pounds for the Trust with the present NHS tariffs.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Plates / economics*
  • Bone Wires / economics*
  • Child
  • Costs and Cost Analysis
  • Female
  • Fracture Fixation, Internal / economics*
  • Fracture Fixation, Internal / instrumentation
  • Humans
  • Male
  • Middle Aged
  • Radius Fractures / economics*
  • Radius Fractures / surgery
  • Retrospective Studies
  • State Medicine / economics*
  • State Medicine / organization & administration
  • Time Factors
  • Treatment Outcome
  • United Kingdom
  • Wrist Injuries / economics
  • Wrist Injuries / surgery
  • Young Adult