Comparison of Direct Surgical Cost for Humeral Shaft Fracture Fixation: Open Reduction Internal Fixation versus Intramedullary Nailing

Abstract: Background and/or Hypothesis Prior literature has supported similar complication rates and outcomes for humeral shaft fractures treated with open reduction internal fixation (ORIF) with a plate/screw construct versus intramedullary nailing (IMN). The purpose of this study is to determine whether surgical encounter total direct costs (SETDC) differ between ORIF versus IMN for these fractures. Methods Adult patients (≥ 18 years) treated for isolated humeral shaft fractures by ORIF or IMN between 6/18/2014 and 6/17/2019 at a single tertiary academic center were available for inclusion. SETDC for ORIF and IMN groups, obtained through our institution’s information technology value tool, were adjusted to 2019 US dollars and converted to relative costs per institutional policy. SETDC for ORIF and IMN were compared using Wilcoxon rank sum test. Results Demographic factors did not differ between ORIF and IMN cohorts with the exception of age (mean of 18.6 years older for IMN; p Discussion and/or Conclusion Our study found that the SETDC for humeral shaft fracture fixation was greater for IMN compared to ORIF, although patient cohorts differed significantly with respect to age and ASA class. Surgeons should take these findings into consideration when consenting patients with humeral shaft fractures for the appropriate fixation type.