Cost of Operative Fixation of Ankle Fractures: Comparing Orthopaedics and Podiatry

Category: Trauma; Other Introduction/Purpose: Ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons are licensed to treat them. Despite increasing emphasis on value-based medical care, there are few cost analyses focused on the treatment of ankle fractures. The goal of this study is to determine if there are cost differences between an orthopaedic surgeon and podiatrist to operatively manage an ankle fracture. Methods: Retrospective cohort study of patients who underwent ankle fracture fixation over a 22 month period at an academic level 1 trauma center. Patient data was subcategorized by surgeon type and treatment groups. Four treatment groups were included: lateral malleolus open reduction and internal fixation (ORIF), bimalleolar/trimalleolar ORIF (no posterior malleolus fixation), lateral malleolus ORIF with syndesmotic fixation, bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation. Primary outcome was total (OR time cost + Implant cost) cost per case. Results: A total of 134 cases met criteria. Eighty-five cases were treated by a total of 4 orthopaedic surgeons while 49 were treated by 8 podiatrists. There was significantly longer OR time (minutes) for lateral malleolus ORIF (111 vs 134.92), lateral malleolus ORIF with syndesmotic fixation (130.53 vs 156.7), and bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation (162.13 vs 208) when podiatry was the treating team. Average total cost per case was significantly more for lateral malleolus ORIF (+$1188.45), lateral malleolus ORIF with syndesmotic fixation (+$2259.16), and bimalleolar/trimalleolar ORIF with syndesmotic fixation (+$2837.29) when podiatry was the treating team. Conclusion: Lateral malleolus ORIF, lateral malleolus ORIF with syndesmotic fixation, and bimalleolar/trimalleolar ORIF with syndesmotic fixation costs less per case when performed by an orthopaedic surgeon based on OR time costs and implant costs.