neighborhood of $4 billion of Medicare spending on spine fusion
operations, saying nothing of the astronomical costs of nonoperative spine
care and the sobering loss of productivity among American workers who
suffer from a “bad back.”^21
TRAUMABone fractures are treated either with nonoperative intervention (like
casts, splints, and slings) or with open reduction and internal fixation.
“Internal fixation” requires plates, screws, pins, and anchors. Every single
bone in the body has certain types of fracture patterns that are best treated
with implanted devices—to not have surgery is to sacrifice the eventual
function of that limb. A wise surgeon knows which fractures to treat with a
cast, and which ones demand an operation. The tabulation below is
therefore exclusively a compilation of surgically treated fractures that
have been addressed with implanted devices.
Fracture fixation of the upper extremities, including clavicle, shoulder,
elbow, wrist, and finger device implantations, totaled 350,388 procedures
in 2016.^22 With an increase of about 25,000 such operations per year, a
retrospective extrapolation of 300,000 internal fixation implantations in
2014 seems reasonable. A total of 1,862,134 internal fixation procedures
were performed on the lower extremities in 2016, and assuming a 6
percent growth in internal fixations over the last decade, a total of
1,627,924 lower extremity implant-related cases were performed in
2014.^23 These include tibia and femur fractures, ankle fractures, pelvis and
hip fractures, and foot fractures. Combined, there were approximately
1,928,000 extremity fracture operations in the United States in 2014, not
counting spine stabilization operations that were previously included
above. By the year 2020, this is expected to pass three million internal
fixation cases per year, due in large part to age-related hip and leg
fractures among the population.
SPORTS MEDICINE