{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:08:59Z","timestamp":1793408939139,"version":"4.5.0"},"reference-count":101,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,2,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient\u2019s lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Economic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00181","type":"journal-article","created":{"date-parts":[[2018,2,7]],"date-time":"2018-02-07T12:24:18Z","timestamp":1518006258000},"page":"e13","source":"Crossref","is-referenced-by-count":28,"title":["The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures"],"prefix":"10.2106","volume":"100","author":[{"given":"Prashant V.","family":"Rajan","sequence":"first","affiliation":[{"name":"Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women\u2019s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rameez A.","family":"Qudsi","sequence":"additional","affiliation":[{"name":"Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women\u2019s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George S.M.","family":"Dyer","sequence":"additional","affiliation":[{"name":"Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women\u2019s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3424-0892","authenticated-orcid":false,"given":"Elena","family":"Losina","sequence":"additional","affiliation":[{"name":"Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women\u2019s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"8","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.2106\/JBJS.H.01297","article-title":"Trends in the United States in the treatment of distal radial fractures in the elderly","volume":"91","author":"Chung","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.jhsa.2004.05.006","article-title":"Augmented external fixation versus percutaneous pinning and casting for unstable fractures of the distal radius\u2014a prospective randomized trial","volume":"29","author":"Harley","year":"2004","journal-title":"J Hand Surg Am."},{"issue":"8","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.2106\/JBJS.H.01478","article-title":"Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. 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