{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:11:31Z","timestamp":1765609891953,"version":"3.37.3"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T00:00:00Z","timestamp":1533772800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T00:00:00Z","timestamp":1533772800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In many low\u2010 and middle\u2010income countries, non\u2010surgical management of femoral shaft fractures using skeletal traction is common because intramedullary (IM) nailing is perceived to be expensive. This study assessed the cost of IM nailing and skeletal traction for treatment of femoral shaft fractures in Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used micro\u2010costing methods to quantify the costs associated with IM nailing and skeletal traction. Adult patients who sustained an isolated closed femur shaft fracture and managed at Queen Elizabeth Central Hospital in Malawi were followed from admission to discharge. Resource utilization and time data were collected through direct observation. Costs were quantified for procedures and ward personnel, medications, investigations, surgical implants, disposable supplies, procedures instruments and overhead.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We followed 38\u00a0nailing and 27 traction patients admitted between April 2016 and November 2017. Nailing patient\u2019s average length of stay (LOS) was 36.35\u00a0days (SD 21.19), compared to 61 (SD 18.16) for traction (<jats:italic>p<\/jats:italic>\u2009=\u20090.0003). The total cost per patient was $596.97 ($168.81) for nailing and $678.02 (SD $144.25) for traction (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). Major cost drivers were ward personnel and overhead; both are directly proportional to LOS. Converting patients from traction to nailing is cost\u2010saving up to day 23 post\u2010admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Savings from IM nailing as compared with skeletal traction were achieved by shortened LOS. Although this study did not assess the effectiveness of either intervention, the literature suggests that traction carries a higher rate of complications than nailing. Investment in IM nailing capacity may yield substantial net savings to health systems, as well as improved clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4750-3","type":"journal-article","created":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T15:50:16Z","timestamp":1533829816000},"page":"87-95","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The Cost of Intramedullary Nailing Versus Skeletal Traction for Treatment of Femoral Shaft Fractures in Malawi: A Prospective Economic Analysis"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2741-349X","authenticated-orcid":false,"given":"Mohamed","family":"Mustafa Diab","sequence":"first","affiliation":[{"name":"Institute for Global Orthopaedics and Traumatology University of California San Francisco San Francisco CA USA"},{"name":"Philip R. Lee Institute for Health Policy Studies University of California San Francisco 3333 California St 94118 San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Shearer","sequence":"additional","affiliation":[{"name":"Institute for Global Orthopaedics and Traumatology University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James G.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Philip R. Lee Institute for Health Policy Studies University of California San Francisco 3333 California St 94118 San Francisco CA USA"},{"name":"Global Health Economics Consortium University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao\u2010Hua","family":"Wu","sequence":"additional","affiliation":[{"name":"Institute for Global Orthopaedics and Traumatology University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Lau","sequence":"additional","affiliation":[{"name":"Institute for Global Orthopaedics and Traumatology University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saam","family":"Morshed","sequence":"additional","affiliation":[{"name":"Institute for Global Orthopaedics and Traumatology University of California San Francisco San Francisco CA USA"},{"name":"Global Health Economics Consortium University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Chokotho","sequence":"additional","affiliation":[{"name":"Beit CURE International Hospital Blantyre Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,8,9]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1596\/978\u20101\u20104648\u20100346\u20108"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(12)61766\u20108"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020\u20101383(03)00290\u20100"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010008\u20100369\u20102"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(12)61690\u20100"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978\u2010012373960\u20105.00335\u2010X"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2013.850014"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2012.704564"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010015\u20103081\u20103"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.9738\/CC48.1"},{"key":"e_1_2_7_12_2","first-page":"362","article-title":"The use of Perkins\u2019 traction in the treatment of femoral shaft fractures","volume":"63","author":"Buxton RA","year":"1981","journal-title":"Bone Joint J"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010006\u20100233\u20105"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102017\u2010000313"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010012\u20101625\u20103"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.120436"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010003\u20100535\u20109"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2013.15.42.2451"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010009\u20100798\u2010x"},{"key":"e_1_2_7_20_2","first-page":"4","article-title":"Comparison of closed femur fracture: skeletal traction and intramedullary nailing cost\u2010effectiveness","volume":"8","author":"Kamau DM","year":"2014","journal-title":"East Afr Orthop J"},{"key":"e_1_2_7_21_2","unstructured":"Richland Technique Manual of SIGN IM Nail and Interlocking Screw System Insertion and Extraction Guide (2012)"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2014.02.017"},{"key":"e_1_2_7_23_2","unstructured":"Trust MCMSThe Central Medical Stores Trust Catalogue (2015)"},{"key":"e_1_2_7_24_2","unstructured":"KramerEJ ShearerDW MarseilleEet al. The cost of intramedullary nailing for femoral shaft fractures in Dar es Salaam Tanzania.World J Surg(2016)10.1007\/s00268\u2010016\u20103496\u2010z26983603"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aorn.2007.11.006"},{"key":"e_1_2_7_26_2","unstructured":"Budget USGsOoMa useful life and disposal value table (2003)"},{"key":"e_1_2_7_27_2","unstructured":"ConverterXEC(2017).https:\/\/www.xe.com. Accessed 1 April 2017"},{"key":"e_1_2_7_28_2","unstructured":"StataCorp.Stata Statistical Software: Release 13. In: College Station TSL editor (2013)"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010013\u20103293\u2010z"},{"key":"e_1_2_7_30_2","first-page":"7","article-title":"Outcome of surgical implant generation network nail initiative in treatment of long bone shaft fractures in Kenya","volume":"3","author":"Soren OO","year":"2009","journal-title":"East Afr Orthop J"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01322"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_7_33_2","unstructured":"World Health O World Health O Choosing interventions that are cost effective (WHO\u2010CHOICE) (2010)"},{"key":"e_1_2_7_34_2","unstructured":"World Health OrganizationGlobal Health expenditure database (2014)"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000078"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2011.636680"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.55095\/achot2015\/003"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-018-4750-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-018-4750-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-018-4750-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-018-4750-3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T23:21:52Z","timestamp":1704928912000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-018-4750-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,9]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1,15]]}},"alternative-id":["10.1007\/s00268-018-4750-3"],"URL":"https:\/\/doi.org\/10.1007\/s00268-018-4750-3","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"type":"print","value":"0364-2313"},{"type":"electronic","value":"1432-2323"}],"subject":[],"published":{"date-parts":[[2018,8,9]]},"assertion":[{"value":"9 August 2018","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}