AI Article Synopsis

  • The study examines the incidence and risk factors of wound complications in minor pediatric orthopaedic surgeries, particularly growth modification procedures.
  • It evaluated data from 622 patients, revealing a complication rate of 6.9% in growth modifications compared to 1.0% in osteotomies, highlighting the significant differences based on surgical techniques and locations.
  • Findings suggest that complications are notably higher with certain implant types and at specific surgical sites, recommending transphyseal screws as a safer option for these surgeries.

Article Abstract

Background: Orthopaedic wound complications are often associated with extensive surgeries and patient medical conditions. However, we noticed wound complications in minor growth modification surgeries in children, including guided growth and epiphysiodesis. Herein, we report the complication rate and risk factors associated with pediatric growth modification surgeries.

Methods: This retrospective study reviewed surgical wound complications in 622 pediatric orthopaedic patients who underwent growth modification surgeries (418 children) or osteotomies (204 children) in the lower extremities in a single center between 2007 and 2019. The grades II and III complications assessed using the modified Clavien-Dindo-Sink complication classification system were compared between growth modification and osteotomy. Risk factors for complications, including the type of surgery, age, body mass index, neuromuscular disease, operation time, surgical sites per patient, surgical location, and implant types, were analyzed using the logistic regression.

Results: The complication rate was 6.9% per patient and 3.6% per surgical site (29 sites in 29 patients comprising 21 grade II and 8 grade III) in the growth modification group, which was >1.0% per patient and 0.6% per site in the osteotomy group (2 sites in 2 patients comprising 2 grade III infections; P =0.001). Among 418 patients with 797 surgical sites in the growth modification group, wound complications were associated with surgical location (5.2% at distal femur vs. 1.0% at proximal tibia, P =0.002) and implant type (0.5% using transphyseal screw vs. 4.3-10.5% using plates or staples, P =0.011).

Conclusion: Surgical wound complication was associated with growth modification surgeries using plates or staples at the distal femur. Our results alert orthopaedic surgeons to this minor but unneglectable problem. Transphyseal screws may be the implant of choice for guided growth and epiphysiodesis at the distal femur in older children, considering the lower risks of wound complication.

Level Of Evidence: Level III, retrospective comparative study.

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Source
http://dx.doi.org/10.1097/BPO.0000000000002201DOI Listing

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