OTA 1997 Posters - Femur Fractures

A Regional Survey of Inventory and Utilization of Intramedullary Femoral Nails

Gerald J. Lang, MD

Madison, Wisconsin, USA

Purpose: To assess the levels of inventory and utilization of intramedullary nails in a well-defined geographic area.

Methods: One hundred and twenty-seven medical/surgical hospitals, in a state with an estimated population of 5.1 million, were queried to see if intramedullary nailing of the femur was performed at their institution, during 1994-1995. Sixty-nine (54%) hospitals responded that they performed the procedure, and fifty-eight responded that they did not. Fifty-two of the sixty-nine hospitals housed interlocking femoral nailing system inventory and instruments in their hospital. The remaining seventeen hospitals used nail sets that were lent from neighboring hospitals or brought in from a vendor. Twelve of the fifty-two institutions that had on-site inventory included nails with second generation (reconstruction) capability. Levels of inventory, utilization and ownership of inventory were obtained from the hospitals and vendors.

Results: Fifty-two institutions had a combined inventory of 3,498 (range 30 to 226) interlocking nails. Throughout a two year period, 1994 and 1995, nine hundred and three nails were utilized. Looking at this on a regional basis, thirteen percent of the available inventory was utilized annually. This ranged from one percent to thirty-two percent, for individual institutions. During this time frame, three hundred and ninety-six nails were added as new sets, or to replace or expand existing inventory at eight hospitals. Seven hospitals had a portion of inventory on consignment, whereas, the remaining forty-five had complete ownership. Five hospitals had sharing agreements with other local hospitals. Hospitals were divided into volume groups 1) 0.5-2 nails/year; 27(40%); 2) 3-6 nails/year 21 (30%); 3) 7-12 nails/year 14 (20%; 4.) > 13 nails/year 7 (10%). The level of inventory and percentage of consignment inventory was greatest in Group 4. (Table 1)

Discussion: Locked intramedullary nailing of the femur has become the standard of care for acute femoral shaft fractures. Many hospitals and orthopaedic surgeons are familiar with the technique and have access to the equipment necessary for the procedure (e.g. fluoroscopy, fracture table, etc.). Inventories of intramedullary nails are quite large, and will likely grow due to the demand for smaller diameter implants, second generation capabilities and retrograde insertion designs being offered by the manufacturers. The vast majority of low volume hospitals (groups 1 & 2) own their own inventory, and have extremely low utilization. On the contrary, larger centers tend to have larger inventories that are utilized to a higher degree.

The low volume centers, that are not geographically isolated, would likely fare better with being served by loaner sets provided by the vendor, or having organized sharing arrangements with neighboring hospitals. Some of this was found during the inquiries, but certainly could be expanded upon. Loaner fees plus shipping costs for nail sets range $0-500.00 and are an attractive alternative to acquiring an entire system.

Conclusion: Except for the busiest of centers, maintaining inventory for intramedullary nailing is quite costly and utilization is low. There does appear to be an excessive amount of inventory, compared to utilization, when viewed on a regional basis.

TABLE I DATA

Group	Nails/Year	Hospital	Have Inventory	Partial Consignment
1	0.5 - 2	27 (40%)	48%	0%
2	3 - 6	21 (30%)	81%	6%
3	7 - 12	14 (20%)	100%	7%
4	> 13	7 (10%)	100%	71%