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Comparison of direct and indirect costs of internal fixation and cast treatment in acute scaphoid fractures: A randomized trial involving 52 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hand Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2007 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 5, 672-679 p.Article in journal (Refereed) Published
Abstract [en]

Background The most cost-effective treatment of scaphoid fractures has not yet been determined. Methods In a prospective trial, 52 employed or selfemployed patients with scaphoid fractures were randomized to closed (cast) or surgical treatment. Results There were 3 complications in the surgical group and 1 in the cast group. Median time off work was numerically but not statistically significantly greater after cast than after surgery (74/39 days). Manual workers (manuals) had a longer time away from work than non-manual employees/individuals who were selfemployed (non-manuals; median 84 days and 16 days, respectively; p < 0.001) and they had a longer time off work after cast than after surgery (median 100 days and 61 days; p = 0.03). Hospital costs were lower after cast than after surgery (p < 0.001). Work disability costs were numerically but not statistically significantly higher after cast than after surgery, and similarly, the total costs were lower after cast than after surgery. Work disability costs and total costs were higher in manuals than in non-manuals (p < 0.001). Non-manuals had lower total costs after cast than after surgery (p = 0.05). Interpretation There was a longer period of absence from work after cast than after surgery in manuals, but not in non-manuals. In non-manuals, total costs were lower after cast than after surgery. Socioeconomic classification had a greater influence on cost than mode of treatment.

Place, publisher, year, edition, pages
2007. Vol. 78, no 5, 672-679 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97265DOI: 10.1080/17453670710014383ISI: 000250516800016PubMedID: 17966028OAI: oai:DiVA.org:uu-97265DiVA: diva2:172125
Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Scaphoid fractures: Studies on diagnosis and treatment
Open this publication in new window or tab >>Scaphoid fractures: Studies on diagnosis and treatment
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority.

The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed.

Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography.

Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers.

Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated.

The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 54 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 358
Keyword
Surgery, Scaphoid Bone, Wrist Joint, Wrist Injuries, Fracture Healing, Cost of Illness, Health Care Costs, Outcome Assessment (Health Care), Arthroplasty, Radiography, Health status, Kirurgi
Identifiers
urn:nbn:se:uu:diva-8845 (URN)978-91-554-7214-6 (ISBN)
Public defence
2008-05-28, Robergsalen, Ing 40, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-05-07 Created: 2008-05-07Bibliographically approved

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Vinnars, BertilGerdin, Bengt

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