{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:09Z","timestamp":1787755449662,"version":"build-2784847793"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,5,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>As the United States transitions to value-based insurance, bundled payments, and capitated models, it is paramount to understand health-care costs and resource utilization. The financial implications of open reduction and internal fixation (ORIF) with a volar locking plate for management of unstable distal radial fractures have not been established. We aimed to elucidate cost differences between ORIF and closed reduction and percutaneous pinning (CRPP). Our hypothesis was that ORIF has greater direct perioperative costs than CRPP but that the costs equilibrate over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We reviewed financial data for 40 patients prospectively enrolled and randomized to undergo CRPP or ORIF for treatment of a closed, displaced, unstable distal radial fracture. Clinical and functional outcomes, hospital-associated direct perioperative costs, postoperative care and therapy costs, and costs for additional procedures were compared. Cost data were stratified into perioperative, 90-day, and 1-year periods, and were reported utilizing cost ratios (CRs) relative to the CRPP cohort. Statistical analysis was performed with chi-square and independent-samples t tests with an alpha level of &lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Seventeen patients underwent CRPP and 23 underwent ORIF with a volar plate. Patients who underwent ORIF incurred greater 90-day (CR = 2.03\/1.0, p &lt; 0.001) and 1-year (CR = 1.60\/1.0, p &lt; 0.001) direct costs than those who underwent CRPP. The differential was greatest in the immediate perioperative period and gradually decreased over time. Operating room fees (CR = 1.7\/1.0, p &lt; 0.001), operating room implants, anesthesia (CR = 1.8\/1.0, p &lt; 0.001), and total perioperative costs (CR = 2.7\/1.0, p &lt; 0.001) were significantly greater in the ORIF cohort. Rehabilitation and cast technician costs were comparable (CR = 0.9\/1.0 [ORIF\/CRPP], p = 0.69). At 1 year, the CR for all costs of decreased to 1.6\/1.0 (ORIF\/CRPP, p &lt; 0.001). Compared with the CRPP cohort, the ORIF cohort demonstrated significantly better functional outcomes at 6, 9, and 12 weeks and similar outcomes at 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ORIF for a displaced, unstable distal radial fracture incurred greater direct costs than CRPP. Although implant costs for ORIF provided the greatest cost differential, additional procedures and higher clinic costs in the CRPP cohort narrowed the 90-day and 1-year cost gaps.<\/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 II<\/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.17.00688","type":"journal-article","created":{"date-parts":[[2018,5,2]],"date-time":"2018-05-02T15:28:43Z","timestamp":1525274923000},"page":"786-792","source":"Crossref","is-referenced-by-count":26,"title":["Comparison of Direct Perioperative Costs in Treatment of Unstable Distal Radial Fractures"],"prefix":"10.2106","volume":"100","author":[{"given":"Sreeharsha V.","family":"Nandyala","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aviram M.","family":"Giladi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber M.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5003-0924","authenticated-orcid":false,"given":"Tamara D.","family":"Rozental","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"g4807","DOI":"10.1136\/bmj.g4807","article-title":"DRAFFT Study Group. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial","volume":"349","author":"Costa","year":"2014","journal-title":"BMJ."},{"issue":"9","key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1302\/0301-620X.97B9.35560","article-title":"Cost-effectiveness of volar locking plate versus percutaneous fixation for distal radial fractures: economic evaluation alongside a randomised clinical trial","volume":"97-B","author":"Karantana","year":"2015","journal-title":"Bone Joint J."},{"issue":"8","key":"bib3-20230811","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. A prospective randomized trial","volume":"91","author":"Rozental","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jhsa.2011.05.017","article-title":"Current and future national costs to Medicare for the treatment of distal radius fracture in the elderly","volume":"36","author":"Shauver","year":"2011","journal-title":"J Hand Surg Am."},{"issue":"8","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1177\/1753193410364179","article-title":"Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate","volume":"35","author":"Marcheix","year":"2010","journal-title":"J Hand Surg Eur Vol."},{"issue":"2","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.injury.2010.07.236","article-title":"Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial","volume":"42","author":"McFadyen","year":"2011","journal-title":"Injury."},{"issue":"19","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.2106\/JBJS.L.00232","article-title":"Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial","volume":"95","author":"Karantana","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jhsa.2003.09.015","article-title":"Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient","volume":"29","author":"Orbay","year":"2004","journal-title":"J Hand Surg Am."},{"issue":"5","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.jhsa.2011.02.005","article-title":"A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly","volume":"36","author":"Diaz-Garcia","year":"2011","journal-title":"J Hand Surg Am."},{"key":"bib10-20230811","first-page":"CD006080","article-title":"Percutaneous pinning for treating distal radial fractures in adults","volume":"3","author":"Handoll","year":"2007","journal-title":"Cochrane Database Syst Rev."},{"issue":"7","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.jhsa.2016.05.016","article-title":"Hand Surgery Quality Consortium. Quality and value in an evolving health care landscape","volume":"41","author":"Kamal","year":"2016","journal-title":"J Hand Surg Am."},{"issue":"6","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.spinee.2012.11.055","article-title":"Cost analysis of anterior-posterior circumferential fusion and transforaminal lumbar interbody fusion","volume":"13","author":"Andres","year":"2013","journal-title":"Spine J."},{"issue":"5","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.2106\/JBJS.I.00879","article-title":"Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases","volume":"92","author":"Kamerlink","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib14-20230811","first-page":"181","article-title":"A cost comparison of mandibular two-implant overdenture and conventional denture treatment","volume":"17","author":"Takanashi","year":"2004","journal-title":"Int J Prosthodont."},{"key":"bib15-20230811","first-page":"CD006194","article-title":"External fixation versus conservative treatment for distal radial fractures in adults","volume":"3","author":"Handoll","year":"2007","journal-title":"Cochrane Database Syst Rev."},{"key":"bib16-20230811","first-page":"CD003209","article-title":"Surgical interventions for treating distal radial fractures in adults","volume":"3","author":"Handoll","year":"2003","journal-title":"Cochrane Database Syst Rev."},{"issue":"7","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1302\/0301-620X.96B7.33149","article-title":"The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study","volume":"96-B","author":"Mellstrand-Navarro","year":"2014","journal-title":"Bone Joint J."},{"issue":"2","key":"bib18-20230811","first-page":"180","article-title":"Percutaneous K-wire fixation versus palmar plating with locking screws for Colles\u2019 fractures","volume":"77","author":"Hollevoet","year":"2011","journal-title":"Acta Orthop Belg."},{"issue":"12","key":"bib19-20230811","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1016\/j.jhsa.2011.09.039","article-title":"An economic analysis of outcomes and complications of treating distal radius fractures in the elderly","volume":"36","author":"Shauver","year":"2011","journal-title":"J Hand Surg Am."},{"issue":"8","key":"bib20-20230811","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1302\/0301-620X.97B8.35234","article-title":"Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the DRAFFT trial","volume":"97-B","author":"Tubeuf","year":"2015","journal-title":"Bone Joint J."},{"issue":"12","key":"bib21-20230811","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.injury.2009.02.018","article-title":"Volar locking plates versus Kirschner wires for distal radial fractures\u2014a cost analysis study","volume":"40","author":"Shyamalan","year":"2009","journal-title":"Injury."},{"issue":"6","key":"bib22-20230811","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1503\/cjs.22712","article-title":"Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation","volume":"56","author":"Dzaja","year":"2013","journal-title":"Can J Surg."},{"issue":"2","key":"bib23-20230811","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s12178-017-9405-8","article-title":"Bundled payments in total joint arthroplasty and spine surgery","volume":"10","author":"Sullivan","year":"2017","journal-title":"Curr Rev Musculoskelet Med."},{"issue":"8","key":"bib24-20230811","doi-asserted-by":"crossref","first-page":"2590","DOI":"10.1016\/j.arth.2017.03.027","article-title":"Effect of bundled payments and health care reform as alternative payment models in total joint arthroplasty: a clinical review","volume":"32","author":"Siddiqi","year":"2017","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib25-20230811","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.arth.2015.09.004","article-title":"Early results of Medicare\u2019s bundled payment initiative for a 90-day total joint arthroplasty episode of care","volume":"31","author":"Iorio","year":"2016","journal-title":"J Arthroplasty."},{"issue":"9","key":"bib26-20230811","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1016\/j.arth.2017.03.058","article-title":"The cost of unnecessary hospital days for Medicare joint arthroplasty patients discharging to skilled nursing facilities","volume":"32","author":"Sibia","year":"2017","journal-title":"J Arthroplasty."},{"issue":"12","key":"bib27-20230811","doi-asserted-by":"crossref","first-page":"2401","DOI":"10.1016\/j.jhsa.2015.08.026","article-title":"Utilization of post-acute care following distal radius fracture among Medicare beneficiaries","volume":"40","author":"Zhong","year":"2015","journal-title":"J Hand Surg Am."},{"issue":"2","key":"bib28-20230811","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1007\/s12178-017-9406-7","article-title":"Medicare reimbursement and orthopedic surgery: past, present, and future","volume":"10","author":"Carter Clement","year":"2017","journal-title":"Curr Rev Musculoskelet Med."},{"issue":"18","key":"bib29-20230811","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.2106\/JBJS.K.00355","article-title":"Variability in costs associated with total hip and knee replacement implants","volume":"94","author":"Robinson","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"21","key":"bib30-20230811","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.2106\/JBJS.15.00831","article-title":"Cost analysis of ceramic heads in primary total hip arthroplasty","volume":"98","author":"Carnes","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"Suppl 5","key":"bib31-20230811","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1097\/BOT.0000000000000719","article-title":"Financial impact of dual vendor, matrix pricing, and sole-source contracting on implant costs","volume":"30","author":"Althausen","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib32-20230811","doi-asserted-by":"crossref","first-page":"607","DOI":"10.2106\/00004623-200005000-00001","article-title":"Single price\/case price purchasing in orthopaedic surgery: experience at the Lahey Clinic","volume":"82","author":"Healy","year":"2000","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib33-20230811","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.arth.2008.03.005","article-title":"Financial impact of a capitation matrix system on total knee and total hip arthroplasty","volume":"24","author":"Taylor","year":"2009","journal-title":"J Arthroplasty."},{"key":"bib34-20230811","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/BLO.0b013e31803372e0","article-title":"Implant selection and cost for total joint arthroplasty: conflict between surgeons and hospitals","volume":"457","author":"Healy","year":"2007","journal-title":"Clin Orthop Relat Res."},{"issue":"10 Suppl","key":"bib35-20230811","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium \u2013 2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201805020-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:43:09Z","timestamp":1787751789000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201805020-00009"}},"subtitle":["Open Reduction and Internal Fixation Versus Closed Reduction and Percutaneous Pinning"],"short-title":[],"issued":{"date-parts":[[2018,5,2]]},"references-count":35,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.17.00688","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,2]]}}}