Trends and Economic Implications of Operative Management for Pediatric Forearm Fractures: A Retrospective Study.

Introduction: Pediatric forearm fractures are traditionally managed conservatively with satisfactory results. However, operative management is trending upward without definitive evidence of superior outcomes. This investigation aims to evaluate trends in the operative management of acute pediatric forearm fractures globally and to estimate the cost of treatment to ascertain management preferences and guidance.

Methods: A retrospective cohort analysis of the TriNetX database (TriNetX, Cambridge, MA, USA) was performed by querying all pediatric patients (ages one to 21) who underwent treatment for radial and ulnar shaft forearm fractures between 2014 and 2024 (n = 30,449). The operatively managed cohort included the percentage of patients who received open treatment (current procedural terminology (CPT): 25575 and/or 25574) each year while the conservatively managed cohort featured patients who received closed treatment (CPT: 25560 and/or 25565) each year. Incidence data for 2024, up to September 4th, was extracted but not included in the trend analysis due to its incomplete representation of the full year. The annual Medicare-designated relative value units and reimbursement conversion factors were utilized to estimate cost. This approach, i.e., utilizing reimbursement rates as proxies, enables a standardized comparison of the financial implications of operative versus conservative treatments over the study period.

Results: From 2014 to 2023, the percentage of fractures managed operatively increased from 13.6% to 17.88%, with a total increase of 4.28% (p-value = 0.001). The reimbursement rate of non-operative treatment increased by 8.56% in treatments without manipulation (CPT: 25560) and a 1.58% increase in treatments with manipulation (CPT: 25565). The reimbursement of operative procedures was essentially unchanged from 2014 to 2024, with an increase ranging from 0.02% (CPT: 25575) to 0.56% (CPT: 25574). From 2014 to 2024, operative treatment had a reimbursement rate ranging from $999.01 to $1349.64, while the rate for conservative treatment ranged from $427.69 to $780.72.

Conclusion: The previously established higher reimbursement rate for operative treatment is confirmed by this study. From 2014 to 2023, the higher cost of operative treatment, represented by higher reimbursement rates, and a statistically significant increase in the percentage of patients who underwent operative treatment for pediatric forearm fractures drove up the cost of treatment. The sequelae of an operative preference are largely unknown but include increased treatment costs without evidence-based claims of superior outcomes.