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Effectiveness and Costs of Demineralized Bone Matrix in Wrist Fusion Procedures
Jacqueline Rose Piggott, MD; Douglas Ross, MD, FRCSC; Christopher Doherty, MD; FRCSC
Plastic and Reconstructive Surgery, St. Joseph's Health Care Center, Western University, London, ON, Canada

Introduction: Wrist fusion is a common procedure indicated for degenerative wrist arthritis, traditionally performed using Iliac crest bone graft (ICBG). Wrist fusion using demineralized bone matrix (DMB) spares ICBG donor site morbidity. Literature describing fusion procedures using DMB is scarce, and the fusion rates using DMB for wrist fusion have never been reported. This study assessed the rate of successful fusion using DMB in wrist fusion procedures. Furthermore, use of DMB in fusion procedures is often avoided due to the presumed high cost. We performed a cost comparison analysis using a specific DBM (Allomatrix®) compared with conventional ICBG in wrist fusion procedures.

Materials & Methods: All patients undergoing partial or total wrist fusion over a six year period in a single surgeon's practice were reviewed. Data collected included: Demographics, risk factors for non-union, operative procedures performed, length of stay, time to union, and complications. Bony union was confirmed clinically and using CT imaging (82% of patients) and plain film radiography (12% of patients). To compare costs associated with using DBM, a matched group of 10 ICBG fusion patients were compared with 10 DBM fusion patients. We compared Direct costs (operative time, operative supplies, intraoperative imaging, nursing, PACU, overnight stay), and Indirect costs (overhead expenses of administration, finances, heating).

Results: Forty patients underwent partial (27.5%) or total (72.5%) wrist fusion using DBM. 45% had risk factors for non-union. All patients except one achieved union at 5.2 weeks post-operatively for a non-union rate of 2.5%. When comparing the DBM to the ICBG group, all DBM patients except those requiring admission for medical comorbidities were treated with outpatient surgery whereas all ICBG patients required admission. Mean operative time for the DBM group was 113 minutes versus 136 minutes for the ICBG group (p = 0.04). For patients undergoing a wrist fusion procedure alone, mean operative time for the DBM group was 90.1 minutes versus 138.3 minutes for the ICBG group (p = 0.003). Average time to union was 5.2 weeks for the DBM group versus 5.9 weeks for the ICBG group (p = 0.51). Mean costs for the DBM group were $2239.71 versus $4033.66 for the ICBG group.

Conclusions: Demineralized bone matrix is an effective bone substitute in achieving bony union in patients undergoing wrist fusion. Although the cost of DBM is significant, a reduction in operative time and an ability to do surgery as an outpatient makes the use of DBM cost-effective.


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