OBJECTIVES:

Segmental bone defects may result from trauma, infection, and malignancy. For bone defects >3cm, treatment typically involves a masquelet within a two-stage surgical technique. This study evaluates postoperative outcomes, costs, and risk factors associated with this procedure.

METHODS:

A retrospective database analysis using the Truven Commercial Claims and Encounters database was designed to include patients with open tibial and/or fibular fractures (“index”) from 2007 to 2016 and ≥ 12-months continuous enrollment post-index. Patients were categorized as “Severe” if they had saucerization and/or insertion of a non-biodegradable drug delivery implant (CPT-4 codes 26540, 11981). All other patients were identified as “Other”. The Severe and Other cohorts were tracked longitudinally for non-union, malunion, infection and post-index amputation. All healthcare encounters with orthopedic diagnoses were identified and cost of care was estimated for each patient over 12 months.

RESULTS: CONCLUSIONS:

Open tibial fractures are associated with high complication rates and significant post-operative costs. Complications are significantly associated with pre-existing diagnoses of smoking and osteoporosis. Further understanding risk factors is important to provide targeted, value-based care.