The following article was published in Orthopedic Network News (ONN), Trauma Update, Volume 22, Number 2, April 2011. To sign up for all ONN editions in print and online, plus all archives, click here: ONN Subscription
As many long-time readers of this publication know, I have written about the various “segments” of orthopedics for a number of years. In January each year, I write about extremities, in April, about trauma, in July, hips and knees, and in October, spine. I enjoy looking at the data that I am able to assemble from a variety of sources, and what I am able to learn during that time.
I will confess that I find the trauma newsletter much more interesting than the others. Although both spine and joint cases have their unique aspects and are larger in dollar volume, the trauma cases are unique as individual cases. Patients receive hip and knee replacements for osteoarthritis, a normal process of aging. Patients receive spinal fusions for back pain (although dressed up in fancier terminology). Patients receive trauma hardware because of a trauma—a fall, a motor vehicle accident, a sports injury, or whatever. The reasons that people get fractures are as different and complicated as life itself— “I was walking from the post office on Main Street and tried to sidestep the dog, and slipped on the ice and broke my wrist…..I intercepted a pass at basketball, and got to midcourt and slipped on some sweat from another player, and fell and broke my ankle…..I was going to the bathroom in the middle of the night, and tripped over the vacuum cleaner and broke my hip.”
Corresponding to these fractures (distal radius, distal tibia, femoral head), are a variety of products designed to treat them— plates, screws, nails, rods, external fixators, etc. And over the years the devices have become much more specific to individual bones than they have been in the past. For example, clavicle fractures were seldom treated 20 or even 10 years ago. Now most of the manufacturers have several types of plates (locking and non-locking) for clavicle fractures. There are plates that are designed for the proximal femur, medial distal tibia, lateral distal tibia, etc. These plates are “pre-bent” for the contours of the specific bone they are designed for. In the past the surgeons had to bend the plates in the operating room, and the “pre-bent” plates save that time, and presumably reduce patient morbidity associated with long surgical times.
What I have found is that certain fractures are incurred by a certain demographic of patient (age and gender), and have certain causes (see page 3). For example, hip fractures are generally sustained by “little old ladies,” as are proximal humerus fractures. Distal radius fractures are generally a younger demographic. Skull fractures are usually younger males involved in motor vehicle accidents.
So when reviewing the products that are designed for these specific fractures, a snapshot of the patient emerges. One of my favorite set of implants are those designed for facial fractures. These are gorgeous plates with intricate designs, and screws 1.5mm in diameter. The plates have to be thin enough so they will not be noticed by the patient, flexible enough to be contoured to the specific bone they are applied to, and strong enough to withstand the forces of contouring. They are literally works of art. The type of patient likely to receive such an implant is a young male involved in a fight.
An external fixator for a pelvis fracture may be for someone involved in an automobile accident. Open pelvic fractures are very often fatal to patients, since they often involved significant force, damage to internal organs, and blood loss.
As we price, negotiate, and analyze these devices, it is important to remember that these components are “patients with their tears wiped off.”