The cost effectiveness analysis in the treatment of closed totally displaced supracondylar humeral fracture in children comparing closed reduction and pinning with open reduction and pinning: A ramdomized controlled trial.

ABSTRACT

To analyse the cost and the effects in terms of the difference in Baumann's angle of the fracture side from the normal side and to compare between closed and open reduction group. To compare the satisfaction, the complication rates and the range of motions between two groups of treatment and to consider the treatment of choice for closed totally displaced supracondylar humeral fracture. Material and Methods: A randomized controlled trial was performed on 20 patients, all with closed totally displaced supracondylar humeral fracture less than 13 years old. Ten cases were in group A closed reduction and pinning and 10 cases were in group B open reduction and pinning. Results: The general characteristics in both groups are not differect in age (mean+ S.D.) = 6.9+ 3.1, 6.3+ 2.8. P = 0.66, 95% CI -2.2, 3.4), sex, side, displacement and nerve injury preoperatively. All cases healed with good range of motion and results. The Baumann's angle difference = 2.53+ 1.8 in group A and 2.09+ 1.7 in group B with no statistical significant difference (P = 0.44, 95% CI = -1.2, 2.08) and also no difference in satisfaction and complications. The total cost, however in provider's perspective and parents' perspective were significantly higher in open reduction group than closed reduction group (P = 0.029, <0.001 respectively). Conclusion: Closed reduction should be considered first as the treatment of choice because of lower cost. In case of failure, open reduction can be performed and wil achieve good results by the experienced surgeon.