1. Belgian Hand Group, 17 11 2007 Social Insurance Costs and Impairment in Displaced Wrist Fractures in Young and Elderly Patients Th. MULIER, P. MILANTS, P. DONCEEL Werchter / Heilig Hart and UZ Leuven Elton John, Rock Werchter 2007

2. Belgian Hand Group, 17 11 2007 INTRODUCTION

3. Belgian Hand Group, 17 11 2007 Case 1 Suicide attempt, 33 y nurse: S.I. cost 9000 E ! Total Medical Cost (TMC) :3166 E Temp Work incapacity (TWC) :5600 E No disability cost, RTW: 6 months0 E

4. Belgian Hand Group, 17 11 2007

5. Case 2 Construction worker, 44 y: 40% Econ.loss ! Fell while working at podium TMCost: 2700 E, TWC: 3850 E 11% impairment, 11% disability: 3650 E / year x 21 Change of work …

6. Belgian Hand Group, 17 11 2007

7. Most common fracture in elderly Increasing in young adults (“hype”) No studies about costs and impairment!

8. Belgian Hand Group, 17 11 2007 PURPOSE Analyze the (SI) cost and impairment in patients with a displaced distal radius fracture (DRF) in two different groups: 1)young economically active 2)elderly patients

9. Belgian Hand Group, 17 11 2007 Types of Costs Direct Medical Cost (DMC) Medical Cost for After Treatment = Total Medical Cost (TMC) Temporary Work Incapacity Cost (TWC) Impairment/Disability Cost (DC) = Overall cost

10. Belgian Hand Group, 17 11 2007 MATERIAL AND METHODS

11. Belgian Hand Group, 17 11 2007 MATERIAL (n=485) Group A: Young ec. active - 105 cases with DRF 17 files medicolegal consults Group B: Elderly,non ec. active - 380 cases with DRF

12. Belgian Hand Group, 17 11 2007 File review / Stat.data analysis METHODS File review / Stat.data analysis (+ML,MDB, KULeuven) : 1. Direct/total medical costs (Gr A + B,485 cases) 2. Work incapacity period :time, grade, cost ( Gr. A,105) 3. Disability for work % and impairment % (OBSI scale) (Gr B, 17 medicolegal cases)

13. Belgian Hand Group, 17 11 2007 METHOD (N=105) Assessment (group A): - Functional: PRWE 100- p score - Clinical: Grip strength, ROM (30 p) - Radiological: Criteria - Complications: Malunion, CRPS…

14. Belgian Hand Group, 17 11 2007 Standard treatment protocol Frykman classification 1-8 Dorsal displaced: Kapandji (1-4): Displaced, non comm. Ext fixation: Displaced, comminuted Ext fixation + pin: Displaced, comminuted Volar displaced: Plating: Smith fractures

15. Belgian Hand Group, 17 11 2007 Kap Pinning:60% Ext fixation:21% Ext fix + pinning:9% Volar Plating:10%

16. Belgian Hand Group, 17 11 2007 RESULTS

17. Belgian Hand Group, 17 11 2007 1.Direct medical cost 1455 Euro (range 645-18650) 19 % preoperative costs, 63 % cost for technical acts (surgery, anaesthesia, implant material),18 % hospital stay

18. Belgian Hand Group, 17 11 2007 Direct Medic.Costs / Gender: 1258 E (male) versus 1522 E (female) (P<0,04)

19. Belgian Hand Group, 17 11 2007 Direct Medical Cost Non Significant : Cost versus age, ASA, functional status residence prior to admission Significant : Cost versus surgeon, type of treatment, gender

20. Belgian Hand Group, 17 11 2007 2. Temporary work incapacity (N=105) Duration of work incapacity: mean 73 days (range: 1–396) Cost of temporary work incapacity: 2244 E

21. Belgian Hand Group, 17 11 2007 3. Impairment / Disability: 7,4% Kapandji 6 % Plate osteosynthesis 8% External fixation 8% Ext fixation plus pinning 9,4% Cost: ? (1850-8966 E/year) times 25 (50000E) Predictive parameters: preop XR, CRPS, DIC

22. Belgian Hand Group, 17 11 2007 4. Return to work: 72% : same work, 12 % Half time 12% : changed to another profession 16% : remained on sick leave ! Higher education: pos. effect on outcome, quicker RTW

23. Belgian Hand Group, 17 11 2007 DISCUSSION

24. Belgian Hand Group, 17 11 2007 1. SI Cost : 4105 Euro Two studies in literature: - Paris study (1999): DMCost 800 E - London study (1968): comp. cost: 85 P Our study: 1960 E / 2244 E / (50000 E) - Reduction of costs ? difficult …

25. Belgian Hand Group, 17 11 2007 2.Impairment: 7,3% -No correl. between PRWE and impairment % -Should also include radiological criteria, clinical and disab. Measurements -High cost (mean 50000 E)

26. Belgian Hand Group, 17 11 2007 3.Duration work incapacity/ RTW 1.Duration: Our series: 11 weeks (73 days) Literature: 5-14 weeks 2.Return to work: Our series: 84% RTW, 16% permanent WI ! Literature: 72-93% RTW

27. Belgian Hand Group, 17 11 2007 4.Which type of treatment ? Best: Kapandji > Plating> Ext fixation Biassed …

28. Belgian Hand Group, 17 11 2007 5. Limitations in our study Total cost of DRF ? (salary cost?, total psych impact?, production loss?) Too small subgroups (in group A) Difficult to compare with other countries Access to figures/costs of insurances Costs depends upon surgeon, hospital, (univ. X 2)…

29. Belgian Hand Group, 17 11 2007 CONCLUSIONS

30. Belgian Hand Group, 17 11 2007 CONCLUSIONS (1) 1. Cost : 4105 Euro (54105 E), higher in female patients. The overall cost is higher in younger patients. Cost of ext fixation and plate fixation is higher then kapandji pinning. 2. In economically active patients, the most important predictive parameter is education level, prereduction shortening and injury compensation.

31. Belgian Hand Group, 17 11 2007 CONCLUSIONS (2) 3. Permanent work incapacity is seen in 16% of the operatively treated cases. 4. A comprehensive view after DRF requires impairment and disability measurements.

32. Belgian Hand Group, 17 11 2007 Thanks ! Dr P.Donceel, L. Desmet, M. Bossens, M. Dubois