Providing Clients with Affordable Alternatives in Today’s Economy - 2009

This newsletter is a reprint of our May 2007 IMEX™ Update titled “Economics of External Skeletal Fixation.” This reprint has been modified to estimate current device prices. Even in the booming economic times of 2007, I felt this issue made an extremely powerful case for the use of external fixation in veterinary practice. In light of the current economy, it seems even more prudent to have economically viable alternatives to offer clients.

Many issues of the IMEX™ Update have focused on proper selection, application, and post-operative care of the external skeletal fixator. However, prior issues have paid little attention to the economics of external skeletal fixation. I have always felt that the external skeletal fixator is the most logical and economical device to enhance a practice’s orthopedic hardware armamentarium after IM pins and wires. This newsletter will compare start-up capital costs for the three major fracture repair devices: the SK™ ESF device, bone plates and screws, and interlocking nails. Hopefully, after comparison of the data you will be convinced how economical external fixation can be and in particular, why the SK™ ESF device from IMEX™ is the most economical of the commonly available mechanical ESF devices.

Fracture Repair Systems Capital Outlay

Before reviewing cost for the various devices, consider the external fixator stands alone in that one can choose to build very simple or very complex frames. Therefore, if a practice chooses to add ESF to its hardware inventory, it can be added in a variety of degrees depending on the philosophy and goals of the practice. For example, a general practice that performs only IM pin and wire repair of long-bone fractures may want to begin the ESF learning curve solely with application of very simple ESF frames. This provides additional support for otherwise stable IM pin/wire repairs of long-bone fractures. Conversely, a practice with a busier fracture caseload and experience level may choose to inventory a greater number of components to allow repair of more challenging, unstable fracture scenarios. In effect, external fixation frames are customized to the demands of the fracture patient, case selection, and practice goals. Often, practices that start with “simple” fixation patients only, gain confidence and progress over time to repair more and more challenging cases. With bone plates and interlocking nails it is difficult, if not impossible, to select simpler hardware constructs for less demanding cases.

IMEX™ SK™ ESF System

In order to compare “apples to apples” when looking at initial set-up costs of the three systems, we will assume maximal external fixator capability is desired. With all devices, we will assume the surgeon desires the ability to handle a variety of patient sizes and breeds – not to include large animals. Also, the assumption is made that the practice owns basic IM pin and wire inventory and basic orthopedic instruments. The data presented here is taken from a lecture titled Economics of ESF and Creating an ESF Pack given by Bob Radasch, DVM at the recent “14th Complete Course in External Skeletal Fixation” at Iowa State University. I have increased Dr. Radasch’s estimates of ESF start-up expense by adding 2.0mm drill bits, pins, and drill sleeves. Costs for bone plates and screws came from the catalog price list of a mid-range cost plate/screw supplier and interlocking nail costs were from a leading nail manufacturer’s price list.

Interlocking Nail System

Bone Plates and Screws

Looking at these total set-up figures as capital expense to inventory a practice with any of the three devices, it is obvious why the SK™ ESF System is the most cost-effective extension of pin and wire fixation. Certainly, each system has its strengths and weaknesses; however, one system is the clear winner from a return on investment standpoint. Ideally, one would own all devices and use which device is best suited to each patient. However, today many pet owners do not have the funds to consider all options. It is our challenge as veterinarians to offer high quality and dependable alternatives to euthanasia.

Among ESF devices, the SK™ by IMEX™ is uniquely designed to be the most economical by providing adequate fracture stability while using simple frames and requiring minimal instrumentation. IMEX™ pioneered the simple frame and minimal instrumentation philosophy at a time when most ESF companies promoted complex full-pin frames and bar augmentation applied with expensive instrumentation. In addition, the SK™ ESF device is designed to be a modular system. If a practice desires increased orthopedic capability, the SK™ device can be readily upgraded to allow construction of hybrid ESF frames for treating problematic juxta-articular fractures and certain growth deformities without necessitating purchase of another device. In short, the modular nature of the SK™ ESF System makes it affordable and practical for the busiest referral center or general practice with orthopedic interest.

Finally, I highly recommend attending the “17th Complete Course in External Skeletal Fixation” (details in side panel) whether your desire is to improve current ESF skills or begin building your knowledge about ESF concepts and principles. Many of our best customers have attended this thorough and comprehensive course and garnered skills immediately available for application in their practice.