Abstract
Background
In high-energy femoral shaft fractures (FSFs), ipsilateral femoral neck fractures
(FNFs) can be missed by conventional trauma computed topography (CT) imaging, resulting
in increased treatment costs and patient complications. Preliminary evidence suggests
that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol
can identify these occult fractures and be feasibly implemented in the trauma setting.
This study aims to establish the economic break-even point for implementing such an
MRI protocol in all high-energy FSFs.
Methods
We used an adapted break-even economic tool to determine whether the costs of a targeted
MRI protocol can be offset by cost-savings achieved through prevention of missed fractures
(thus avoiding prolonged admission and re-operation). Sensitivity analyses were performed
to demonstrate reliability of the economic modelling across a range of assumptions.
Results
Assuming a baseline of FNFs missed on CT of 12%, an MRI cost of £129 and cost of treating
each missed FNF of £2457.5, the equation yielded a break-even rate of 7% and absolute
risk reduction (ARR) of 5%, indicating that for every 100 FSFs, MRI would need to
diagnose 5 of the 12 missed FNF to be economically viable (number needed to treat
(NNT)=20). Economic viability was maintained even at double the cost of MRI, while
increasing the cost of treating each complication served to reduce the ARR further,
increasing cost-savings.
Conclusion
A rapid, limited-sequence MRI protocol to exclude occult ipsilateral FNFs in all high-energy
FSFs appears to be economically justified measure. Further research exploring the
feasibility of such a protocol, as well as the role of intra-operative fluoroscopy
in this context, is required.
Keywords
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Article info
Publication history
Published online: October 07, 2022
Accepted:
October 6,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
