Supply issues aren’t really an issue, orthopedic operations like this aren’t exactly emergent care. If you have time to procure a tibial nail there isn’t a reason you wouldn’t be able to get a fibular nail at the same time.

As far as cost, the same logic applies. When an orthopedist is coming up with a treatment plan you submit the treatment plan that would best lead to the overall best outcome for the patient, you don’t really formulate based on the most economic outcome.

The insurance company isn’t going to deny a fibular nail, but approve a tibial one. If they are going to go out of pocket, the cost of the fibular nail would be negligible when compared to the overall cost of the operation. The most expensive aspect of an orthopedic moderation is the operating room and the anesthesia, not the additional hardware or operating time.