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Introduction: Fractures occur in children at an incidence only surpassed by women >85 years and account for 25 % of paediatric injuries. Over the last three decades, there has been a trend towards operative management of children's fractures including utilisation of flexible nails as popularised by the Nancy group in the 1980s. Between 5 and 11 % of paediatric forearm fractures are now fixed in this manner with complication rates of 12-42 %. This study shares the experience of a paediatric level one major trauma centre using this technique in managing long bone fractures in children. Methods and materials: This retrospective cohort study comprises a sequential series of 109 cases (71 children) of upper and lower limb fractures in children (aged 16 years and below) who underwent fracture fixation using flexible intramedullary nails between 1st April 2015 and 31st March 2019. Radiological and clinical outcomes and complications were assessed. Results: Ninety-three cases (10 in the lower limb, 83 in the upper limb) satisfied the inclusion criteria in 57 children with a mean age of 8.6 years. All cases were successfully reduced intra-operatively and 92 (98.9 %) achieved union. Taking into account all complications in the upper and lower limb, the overall complication rate is 30.1 % (28 cases) with the vast majority (13 cases, 46.4 %) occurring in the upper limb due to prominence of metalwork prompting early removal. Conclusions: This study has shown flexible intramedullary nailing to perform well with good stabilisation of a wide variety of paediatric long bone fractures with restoration of bone alignment, satisfactory outcomes with good union rates and a return to normal function. The technique is also safe and in the upper limb can be performed as day-case surgery by a generalist orthopaedic surgeon. Although the overall complication rate is not insignificant, major complications are rare.
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BACKGROUND: Superficial surgical site infection (SSI) is a common morbidity following bowel resection surgery involving stoma formation with clinical and financial implications. The study aimed to evaluate the role of topical skin adhesive, 2-octylcyanoacrylate (Dermabond®) (2-OCA) in reducing wound infections following colorectal stoma surgery. METHODS: We performed a retrospective, single-centre, cohort study using clinical notes. All patients, over the age of 18, undergoing bowel resection either elective or emergency, with stoma formation over five years from January 2015 to December 2019 were included. The primary endpoint was SSI, defined by the clinical manifestation of inflammation including pain, erythema, and discharge, regardless of the microbiological culture results. Patients received either 2-OCA glue as wound dressing or standard firm adhesive wound dressing e.g. Opsite. RESULTS: Overall, 604 patients were included in the study. The median age was 67; 187 (31%) patients received Dermabond (Group 1) and 417 (69%) received standard care (Group 2). A total of 288 (47%) patients were female, 134 (22%) had body mass index (BMI) greater than 30, 87 (14%) were diabetic, and 90 (15%) were smokers. A total of 279 (46%) patients had an American Society of Anesthesiologists (ASA) score of 3 and 4; 282 (47%) patients went through emergency surgery, 279 (64%) patients underwent dirty surgery, and 220 (35%) patients developed SSI. BMI greater than 30 compared to < 30 (OR: 2.32, 95% CI: 1.54-3.49, p<0.0001), diabetes compared to no diabetes (OR: 0.54, 95% CI: 0.32-0.92, p<0.0241), dirty surgery compared to clean surgery (OR: 2.26, 95% CI: 1.51-3.37, p<0.0001) and standard care, no 2-OCA glue use compared to the use of 2-OCA glue (OR: 1.52, 95% CI: 1.03-2.24, p=0.0343) were associated with SSIs. Conclusion: Our study demonstrates that there is an association between 2-OCA and reduced SSIs in bowel resection surgery involving stoma formation when compared to standard methods of wound dressing. Further randomised clinical trials are recommended to strengthen this evidence and demonstrate causation.
