FastFrame Knee Spanning External Fixation Associated With Lower Cost Than Modular Frame Configurations: A Comparative Cohort Study.

Abstract

External fixation costs have been identified as a primary driver of initial cost in the care of tibial plateau fractures. Because hospital systems and institutions pursue value-based care, external fixation choices become a uniquely surgeon-dependent driver of cost. Our objective was to determine differences in cost in a prepackaged, single-use, external fixation system compared with standard, modular, knee spanning frames. Secondary objectives were to determine differences in surgical time and loss of distraction between the two types of fixation. This was a retrospective cohort study at an academic level 1 trauma center. Fifty-nine patients were treated with knee spanning external fixation over a 7-year period (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association 41-B/C). Patients received either the Zimmer FastFrame external fixator or a conventional-style, modular, external fixator. The primary outcome was implant and supply cost. The secondary outcomes were operating room facility cost, surgical time, and percent of distraction lost. The FastFrame cohort demonstrated a 24.9% decrease in surgical times (29.2 vs. 38.9 minutes, P = 0.002), with a 37% decrease in supply and implant cost of conventional cohort (0.63x vs. 1x, P < 0.001). Operating room facility cost was less than the conventional cohort (0.72x vs. 1x, P = 0.41), and total cost was 21.8% less (0.78x vs. 1x, P = 0.07), although these did not reach statistical significance. The Fastframe cohort lost less distraction (72.6% vs. 62.8%, P = 0.02). The FastFrame demonstrates a lower supply and implant cost, faster surgical times, and demonstrated clinical equivalence in regard to loss of distraction when compared with conventional, modular, external fixator. Diagnostic-Level III.