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Submitted: 04 December 2014 Modified: 24 September 2015
HERDIN Record #: R07-CVHRDC-14120401540274

Cast treatment and intramedullary nailing for tibial shaft fractures - a cost analysis

Frederick  G. Sarmen

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Design: This study is a retrospective research of patients with Closed Tibial Fractures treated at Vicente Sotto Memorial Medical Center.


1. In patients and out patients seen at the VSMMC from Jan. 1 to Dec. 31, 2002 with Closed Tibial Fractures.

2. Males and females, Filipino with age ranging from 20 to 60 years old.


1. Pathologic Fractures secondary to tumor

2. Neglected Tibial Shaft Fractures

3. Comminuted Tibial Shaft Fractures


    Fractures of the shaft of the Tibia cannot be treated by simple set of rules. By its very location the tibia is exposed to frequent injury.

    The indications for operative and non-operative treatment of tibial shaft fractures have not well defined. Sarmiento, Nicoli, and others have found that closed treatment with casting of functional bracing is an effective method of treatment for many tibial shaft fractures that avoids the potential complications of surgical intervention.

    The amount of malalignment and shortening considered acceptable also is controversial. In general, we agreed with Trafon's recommendation and strive to achieve less than 5 degrees of varus - valgus angulation, less than 10 degrees of anteroposterior angulation, less than 10 degrees of rotation and less than 15 mm of shortening. Maintaining fracture aligument is difficult in certain fracture types and if repeated attempts at realignment have been unsuccessful, an operative fixation is indicated.


    The materials consists of 23 fractures treated between Jan. 1, 2002 and Dec. 31, 2002 at VSMMC. The charts of these patients were retrieved from the Medical records as well as the OPD files and x - ray films of these patients were also retrieved from the x-ray department. Patients were classified into two groups according to the treatment modality.

   1. CR + Casting group, 12 patients treated with the closed reduction and application of plaster cast with mean initial displacement of 36% and;

   2. IMN group, 11 patients treated with intramedullary nailing with mean initial displacement of 47%.

   The cost caused by the treatment, hospitalization, outpatient appointments (direct cost) as well as lost productivity (indirect cost) were taken into account.

 Results :

   Direct costs per patient were 5,250 in patient treated with casting and 12,542 in patients treated with intramedullary nailing. The higher overall costs of patients treated with casting groups were attributable to the longer sick leave periods in these groups (Casting: 210 days) as compared with patients treated with intramedullary nailing (150 days).


Publication Type
Research Report
January 1-December 31, 2002


To compare the relative costs of two different treatment modalities in the treatment of the Closed Tibial Fractures.

LocationLocation CodeAvailable FormatAvailability
Vicente Sotto Memorial Medical Center Fulltext Print Format
1. Rockwood, C. , Green, D. et al. . Rockwood and Green. 2001.
2. Haines, JF , Williams, EA , Hargadon, ES et al. . "Is conservative treatment of displaced tibial shaft fractures justified?" J Bone Joint Surgery , 1984
3. Campbell, W et. al . Campbells. 1998.
4. Henley , MB . "Intramedullary devices for tibial fracture stabilization." Clin Orthop , 1989
5. Hooper, GJ , Laddell , RG , Penny , ID . "Conservative management of closed nailing for tibial shaft fractures. A randomized prospective trial." J Bone Joint Surgery , 1991
6. Sarmiento, A , Gersten, LM , Sobol, PA et al. . "Tibial Shaft fractures treated with functional braces." J Bone Joint Surgery , 1989

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