Long bone fractures: treatment patterns and factors contributing to use of intramedullary nailing

ABSTRACT

Background

This study evaluated treatment patterns for long bone fractures and factors that contribute to use of intramedullary nails (IMN).

Methods

Patients from IBM MarketScan® Research Commercial and Medicare Databases with femoral/tibial/humeral fractures during inpatient admission between January 2016-July 2019 were identified. Patients were categorized by treatment (i.e., non-surgical/internal fixation [extramedullary internal fixation/plating]/IMN/external fixation). Four-year rates of IMN were reported by fracture type. Logistic regression evaluated factors contributing to IMN use.

Results

14,961 femoral, 14,101 tibial, and 7,059 humeral fracture patients were identified (mean[SD] age was 45.3[18.9], 42.0[16.3], and 39.8[21.6] years and % female 50.8%, 47.7%, and 55.3%, respectively). Mean(SD) lengths of stay were 6.7(9.2), 5.9(7.0), and 5.8(10.3) days, rates of surgical treatment were 74.3%, 84.0%, and 62.7%, and rates of IMN among surgical patients were 46.6%, 27.1%, and 6.7% for femoral, tibial, and humeral fractures, respectively. IMN was the predominant treatment for femoral fractures over the past 4 years. Factors contributing to IMN use included open/closed diaphyseal fractures, pathological fractures, diagnoses of cancer or AIDS/HIV, and alcohol abuse.

Conclusions

IMN was the predominant treatment for femoral fractures and use slightly increased for tibial/humeral fractures. Open/closed diaphyseal fractures, pathological fractures, cancer or AIDS/HIV, and alcohol abuse contributed to IMN use.

KEYWORDS:

• Long bone fractures
• healthcare resource utilization
• intramedullary nailing (IMN)
• predictors
• length of stay
• retrospective claims database evaluation

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

A Chitnis, C Sparks, Y Grebenyuk, M Vanderkarr, and C Holy are employees of JnJ; and A Chitnis, C Sparks, Y Grebenyuk, M Vanderkarr, and C Holy own stocks in the company. B Ray was a contractor with JnJ at the time of the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This study was funded by Johnson & Johnson (JnJ).