BackgroundIn the spectrum of surgical decision-making, wound closure material is often an afterthought. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. Less clear is the effect of closure material on the incidence of non-infectious wound complications.The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods.MethodsEligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. Time for skin closure was recorded. Wounds were assessed for complications for six weeks. The incidence of complications was compared using Fisher’s exact test. Time to close and pain with removal of closure material were compared using a Student’s t-test.ResultsThe total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52–1.14). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6–7.1) than the suture group (mean=12 min, CI = 7.9–16). Patients in the staple group (mean=3.7, CI =2.8–4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6–3.4).ConclusionsThis study suggests that 42% of patients report a wound complication with no difference between sutures and staples. It was demonstrated that suturing skin requires more time and staples are more painful to remove.Trial registrationClinicaltrials.gov identifier NCT01146236 (registered June 14, 2010)

Excessive heterogeneity exists in the literature to determine the internal and transfer validity of arthroscopic simulators currently available. Evidence suggests that simulators can discriminate between novice and expert users, but discrimination between novice and intermediate trainees in surgical education should be paramount. International standards for the assessment of arthroscopic simulator validity should be developed to increase the use and effectiveness of simulators in orthopedic surgery.

Objectives Advanced age is a factor associated with altered fracture healing. Delays in healing may increase the incidence of complications in the elderly, who are less able to tolerate long periods of immobilization and activity restrictions. The following study sought to determine if fracture repair could be enhanced in elderly animals by inhibiting macrophage activation, blocking the M-CSF receptor c-fms, and inhibiting monocyte trafficking using CC chemokine receptor-2 (CCR2) knockout mice. Methods Closed, unstable tibial shaft fractures were produced in mice aged four, 12 and 78 weeks. Mice were then fed a diet containing PLX3397 or a control diet from days 1–10 post-injury. Fractures were similarly made in CCR2−/− mice aged 78 weeks. The fracture callus was collected during fracture healing and was assessed for its size and the presence of macrophages, both of which were evaluated using the Mann-Whitney U test. Results PLX3397 treatment resulted in a decrease in the number of macrophages in the fracture callus at Day 5. Calluses in juvenile mice trended towards being smaller compared to elderly mice (p=0.08). There was also a trend toward larger callus size and increased bone formation in PLX3397-treated elderly animals compared to those of the control animals (p=0.12). Similar increases in bone formation (p=0.013) and decreases in cartilage within the callus (p=0.03) were seen at Day 10 in CCR2−/− mice. Conclusions The inhibition of macrophages in elderly mice may lead to an acceleration of fracture healing. Altering macrophage activation after fracture may represent a therapeutic strategy for preventing delayed healing and nonunion in the elderly.