INTRODUCTION

Belgian Hand Group, 17 11 2007

Social Insurance Costs and Impairment in Displaced Wrist Fractures in Young and Elderly Patients

Th. MULIER , P. MILANTS , P. DONCEEL

Werchter / Heilig Hart and UZ Leuven

Elton John , Rock Werchter 2007

INTRODUCTION

Case 1

Suicide attempt, 33 y nurse: S.I. cost 9000 E !

Total Medical Cost (TMC) : 3166 E

Temp Work incapacity (TWC) : 5600 E

No disability cost, RTW: 6 months 0 E

Case 2Construction worker, 44 y: 40% Econ.loss !

Fell while working at podium

TMCost: 2700 E, TWC: 3850 E

11% impairment, 11% disability: 3650 E / year x 21

Change of work …

• Most common fracture in elderly• Increasing in young adults (“hype”)

No studies about costs and impairment!

PURPOSE Analyze the (SI) cost and impairment in

patients with a displaced distal radius fracture (DRF) in two different groups:

1) young economically active 2) elderly patients

Types of Costs

• Direct Medical Cost (DMC)

• Medical Cost for After Treatment

= Total Medical Cost (TMC)

• Temporary Work Incapacity Cost (TWC)

• Impairment/Disability Cost (DC)

= Overall cost

MATERIAL AND METHODS

MATERIAL (n=485) Group A: Young ec. active- 105 cases with DRF 17 files medicolegal consults

Group B: Elderly,non ec. active- 380 cases with DRF

METHODS

File review / File review / Stat.Stat.data analysisdata analysis (+ML,MDB, KULeuven)

1. Direct/total medical costs (Gr A + B ,485 cases)

2. Work incapacity period :time, grade, cost ( Gr. A,105)

3. Disability for work % and impairment % (OBSI scale) (Gr B, 17 medicolegal cases)

METHOD (N=105)

Assessment (group A):

- Functional: PRWE 100- p score

- Clinical: Grip strength, ROM (30 p)

- Radiological: Criteria

- Complications: Malunion, CRPS…

Pols1.mpg

Standard treatment protocol

Frykman classification 1-8

Dorsal displaced:• Kapandji (1-4): Displaced, non

comm.• Ext fixation: Displaced, comminuted • Ext fixation + pin: Displaced, comminuted

Volar displaced:• Plating: Smith fractures

• Kap Pinning:60%

• Ext fixation:21%• Ext fix + pinning:9%

• Volar Plating:10%

RESULTS

1.Direct medical cost

1455 Euro (range 645-18650)

• 19 % preoperative costs, 63 % cost for technical acts (surgery, anaesthesia, implant material) ,18 % hospital stay

Direct Medic.Costs / Gender:

1258 E (male) versus 1522 E (female)(P<0,04)

Direct Medical Cost

• Non Significant :

Cost versus age, ASA, functional status residence prior to admission

• Significant :

Cost versus surgeon, type of treatment, gender

2. Temporary work incapacity (N=105)

• Duration of work incapacity: mean 73 days (range: 1–396)

• Cost of temporary work incapacity: 2244 E

3. Impairment / Disability: 7,4%

Kapandji 6 %

Plate osteosynthesis 8%

External fixation 8%

Ext fixation plus pinning 9,4%

• Cost: ? (1850-8966 E/year) times 25 (50000E)• Predictive parameters: preop XR, CRPS, DIC

4. Return to work:

72% : same work, 12 % Half time

12% : changed to another profession

16% : remained on sick leave !

• Higher education: pos. effect on outcome, quicker RTW

DISCUSSION

1. SI Cost : 4105 Euro

Two studies in literature:

- Paris study (1999): DMCost 800 E

- London study (1968): comp. cost: 85 P

Our study: 1960 E / 2244 E / (50000 E)

- Reduction of costs ? difficult …

2.Impairment: 7,3%

- No correl. between PRWE and impairment %

- Should also include radiological criteria, clinical and disab. Measurements

- High cost (mean 50000 E)

3.Duration work incapacity/ RTW

1.Duration: Our series: 11 weeks (73 days)

Literature: 5-14 weeks

2 .Return to work:Our series: 84% RTW, 16% permanent WI !

Literature: 72-93% RTW

4.Which type of treatment ?

• Best: Kapandji > Plating> Ext fixation

• Biassed …

5. Limitations in our study

• Total cost of DRF ? (salary cost?, total psych impact?, production loss?)

• Too small subgroups (in group A)

• Difficult to compare with other countries

• Access to figures/costs of insurances

• Costs depends upon surgeon, hospital, (univ. X 2)…

CONCLUSIONS

CONCLUSIONS (1)

1. Cost : 4105 Euro (54105 E), higher in female patients. The overall cost is higher in younger patients. Cost of ext fixation and plate fixation is higher then kapandji pinning.

2. In economically active patients, the most important predictive parameter is education level, prereduction shortening and injury compensation.

CONCLUSIONS (2)

3. Permanent work incapacity is seen in 16% of the operatively treated cases.

4. A comprehensive view after DRF requires impairment and disability measurements.

Thanks !

Dr P .Donceel, L. Desmet, M. Bossens, M. Dubois

INTRODUCTION

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