Cost Comparison of Intramedullary Screw Fixation Versus Open Reduction and Internal Fixation With Plate and Screw Technique for Metacarpal Fractures

Background: Intramedullary screw (IMS) fixation for metacarpal fractures is a relatively new fixation technique in comparison to plate and screw constructs. Our hypothesis evaluated whether IMS fixation for metacarpal fractures results in lower overall health care-associated costs in comparison to open reduction and internal fixation (ORIF).

Methods: A retrospective review of patients undergoing IMS fixation for metacarpal fractures at a single center during 2018 to 2022 was conducted. Health care-associated costs included primary operative costs (surgical time and implant(s)) and postoperative costs (therapy, splinting, and radiology). Costs were compared with age-matched and fracture pattern-matched controls who underwent ORIF with plate and screw construct. Subgroup analysis of cost outcomes excluding outliers was completed.

Results: Eight subjects met the inclusion criteria and matched with an ORIF group. Primary operative costs were significantly higher in the ORIF group (mean difference of $1830, 95% CI: $1006 to $2653) The cost of an IMS at our institution was $584, whereas the average cost for plate and screw construct was $2538 (mean difference of $1953, 95% CI: $1665 to $2243). Total surgical costs were on average $3784 more for the ORIF group (95% CI: $2869 to $4700). There was no significant difference in outpatient follow-up costs (95% CI: -$441 to $3180). Total overall costs were significantly lower for the IMS group (95% CI: $2693 to $6513).

Conclusions: Total primary operative costs and overall health care-associated costs for IMS fixation of metacarpal fractures is significantly lower than ORIF. There was no statistical difference in follow-up care costs. To better determine the indirect costs for patients, high-powered prospective studies will be required.