Comparison Of Closed Femur Fracture: Skeletal Traction And Intramedullary Nailing Cost-effectiveness

Abstract

Background: Fractures of the femur are common injuries affecting the productive age group. Skeletal traction is the mainstay of treatment in Kenya, hence comparison with operative management, to determine which is more cost-effective. No similar study has been done in Africa. Objective: To determine the cost-effectiveness of skeletal traction compared to intramedullary nailing. Design: Prospective conventional sampling analytical study. Setting: Hospital based study in a referral and teaching institution - Kenyatta National Hospital in the orthopaedic wards. Study population: Patients admitted at Kenyatta National Hospital with diaphyseal femur fracture between 18 – 50 years. Duration of study: October 2012 – May 2013. Materials and methods: A structured data collection sheet was used. It included the patient particulars, hospital stay and per diem cost, the type of injury, type of management and comparing the cost of each, x-ray findings during treatment and at 3 months to assess for union. Data was represented in form of tables, graphs and charts. Results: Males were more affected than females, with a mean age of 31.5 years. The mean length of hospital stay was 11.48 days for the operative group and 66.7 days for the skeletal traction group. The average total hospital cost for the operative group was 54, 380.44 Kshs compared to 67, 792Kshs for the traction group. In the operative group 24 patients had union with one delayed union while the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal traction, with a better outcome.