Objective: To investigate the factors affecting surgical site infections (SSI) in patients undergoing orthopaedic surgery. Methods: The electronic medical records of patients undergoing orthopaedic surgery between September 2010 and July 2018 were retrospectively retrieved and reviewed. Logistic regression analyses were used to analyse the correlation between surgery-related variables and SSI. The odds ratio (OR) and 95% confidence interval (CI) were estimated for the risk factors. Results: Clinical data from 25 954 patients were reviewed and 804 (3.1%) were found to have become infected at the surgical site. Older age (!60 years) was a risk factor (OR 2.218) and younger age (<18 years) was a protective factor (OR 0.258). Diabetes mellitus (OR 6.560) and hypertension (OR 3.991) were independent risk factors. Compared with type II incisions, type I incisions had a lower risk for SSI (OR 0.031), while type III incisions had a greater risk of SSI (OR 2.599). Compared with upper limbs and hands, the feet had a lower risk of infection, while surgery performed at the spine and joints did not increase the risk as compared with foot surgery. Conclusion: Older age, hypertension, diabetes mellitus and type III incisions were risk factors for SSI following orthopaedic surgery.

Background Fracture nonunion/delayed union seriously affects physical and mental health and quality of life. The aim of this study was to evaluate the relative efficacy of different adjuvant treatments for nonunion/delayed union by network meta-analysis. Methods A comprehensive search was performed to identify randomized controlled trials (RCTs) evaluating adjuvant treatment in the management of nonunion/delayed union. A network meta-analysis reporting on healing rate, healing time, and adverse effect (AE) outcomes was conducted to assess and compare different interventions. Results Thirty studies were included in the analysis. For the healing rate outcome, bone marrow aspirate (BMA) + autologous cancellous bone (ACB) was found to be significantly better than ACB alone (odds ratio: 0.12; 95% confidence interval: 0.03, 0.59). In the ranking results, BMA+ platelet-rich plasma (PRP) (96%), BMA + ACB (90%), and BMA alone (82%) showed relative advantages in the healing rate. Low-intensity pulsed ultrasonography (LIUS) intervention significantly shortened the healing time compared with ACB (SMD: -9.26; 95% CI: − 14.64, − 3.87). LIUS (100%), BMA + PRP (74%), and bone morphogenetic proteins (BMPs) (69%) have relative advantages. Compared with the control, electromagnetic field (EMF) (OR: 13.21; 95% CI: 1.58, 110.40) and extracorporeal shock wave (ESWT) (OR: 4.90; 95% CI: 1.38, 17.43) had a higher AE risk. Conclusions Among the current intervention strategies, BMA in combination with PRP and ACB can improve the healing rate of nonunion/delayed union. LIUS can significantly shorten the healing time. EMF and ESWT may have a high risk of AE. However, large-scale, well-designed studies are still needed to confirm the results. Trial registration Retrospectively registered.

BackgroundFracture nonunion/delayed union seriously affects physical and mental health and quality of life. The aim of this study was to evaluate the relative efficacy of different adjuvant treatments for nonunion/delayed union by network meta-analysis.MethodsA comprehensive search was performed to identify randomized controlled trials (RCTs) evaluating adjuvant treatment in the management of nonunion/delayed union. A network meta-analysis reporting on healing rate, healing time, and adverse effect (AE) outcomes was conducted to assess and compare different interventions.ResultsThirty studies were included in analysis. For healing rate outcome, bone marrow aspirate (BMA) + autologous cancellous bone (ACB) was found to be significantly better than ACB alone (Odds ratio: 0.12; 95% confidence interval: 0.03, 0.59). In the ranking results, BMA+ platelet-rich plasma (PRP) (96%), BMA+ACB (90%), and BMA alone (82%) showed relative advantages in healing rate. Low-intensity pulsed ultrasonography (LIUS) intervention significantly shortened the healing time compared with ACB (Standardized mean difference: -8.93; 95% confidence interval: -14.37, -3.48). LIUS (99%), BMA+PRP (74%), and bone morphogenetic proteins (BMPs) (69%) have relative advantages.ConclusionsAmong the current intervention strategies, BMA and combination with PRP and ACB can improve the healing rate of nonunion/delayed union. LIUS can significantly shorten the healing time. However, large-scale, well-designed studies are still needed to confirm the results.Trial registration: retrospectively registered