Browsing by Author "Cavallero, Matthew"

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    Costs and Complications of Single Stage Fixation Versus Two-Stage Treatment of Select Bicondylar Tibial Plateau Fractures
    (Wolters Kluwer, 2018-03) Virkus, Walter W.; Caballero, Jesse; Kempton, Laurence B.; Cavallero, Matthew; Rosales, Rich; Gaski, Greg; Orthopaedic Surgery, School of Medicine
    Objectives: To determine the differences in costs and complications in patients with bicondylar tibial plateau (BTP) fractures treated with one stage definitive fixation compared to two stage fixation following initial spanning external fixation. Design: Retrospective cohort study Setting: Level one trauma center Patients/Participants: Patients with OTA 41-C (Schatzker 6) treated with open reduction internal fixation (ORIF). Intervention: Definitive treatment with ORIF either acutely (one stage) or delayed following initial spanning external fixation (two stage). Main Outcome Measures: Wound healing complications, implant costs, hospital charges, PROMIS outcome measures. Results: 105 patients were identified over a three-year period, of which 52 met inclusion criteria. There were 28 patients in the One-Stage group and 24 patients in the Two-Stage group. Mean follow-up was 21.8 months, and 87% of patients had at least 12 months follow-up. The mean number of days to definitive fixation was 1.2 in the One-Stage group and 7.8 in the Two-Stage group. There were no differences between groups with respect to wound healing or any other surgery-related complications. Functional outcomes (PROMIS) were similar between groups. Mean implant cost in the Two-Stage group was $10,821 greater than the One-Stage group, mostly due to the costs of external fixation. Median hospital inpatient charges in the Two-Stage group exceeded the One-Stage group by over $68,000 for all BTP fractures and by $61,000 for isolated BTP fractures. Conclusions: Early single stage treatment of BTP fractures is cost effective, and is not associated with a higher complication rate than two stage treatment in appropriately selected patients. Level of Evidence: Level III- Retrospective cohort study
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    Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit
    (Wolters Kluwer, 2018-05) Cavallero, Matthew; Rosales, Richard; Caballero, Jesse; Virkus, Walter W.; Kempton, Laurence B.; Gaski, Greg E.; Orthopaedic Surgery, School of Medicine
    Objectives: To compare outcomes and costs between locking and nonlocking constructs in the treatment of bicondylar tibial plateau (BTP) fractures. Design: Retrospective cohort study. Setting: Level 1 academic trauma center. Patients: All patients that presented with complete articular, BTP fractures (AO/OTA 41-C and Schatzker 6) between 2013-2015 were screened (n=112). Patients treated with a mode of fixation other than plate-and-screw were excluded. 56 patients with a minimum follow-up of 12 months were included in the analysis. Intervention: Operative fixation of BTP fractures with locking (n=29) or nonlocking (n=27) implants. Main outcome measurements: Implant cost, patient reported outcomes (PROMIS physical function and pain interference), clinical, and radiographic outcomes. Results: There were no differences between the two groups with respect to demographics, injury characteristics, radiographic outcomes (change in alignment) or clinical outcomes (PROMIS, reoperation, nonunion, infection). Implant costs were significantly greater in the locking group compared to the nonlocking group (mean L $4453; mean NL $2569; p<0.01). Conclusions: This study demonstrated improved value of treatment (less cost with no difference in clinical outcome) with nonlocking implants for bicondylar tibial plateau fractures when dual plate fixation strategies are performed. Level of Evidence: Therapeutic III. See Instructions for Authors for a complete description of levels of evidence.