Abstract
Introduction
A recent meta-analysis published in the British Medical Journal suggested an increased risk of infection, but none of the studies were large enough to reach statistical significance. A prospective, randomised trial was designed at our institution to investigate the wound healing and complications related to surgery following fracture neck of femur in the elderly.
Objectives
The primary aim was to compare the wound problems and infection following two different methods of skin closure: Subcuticular monocryl suture to metal clips for closure of skin. The secondary aim was to look at the duration of surgery after both types of closure. We received ethical approval for this study. We screened and recruited all eligible patients admitted with acute hip fracture undergoing hemi-arthroplasty or dynamic hip screw.
We recruited 541 patients in the study over the period of 3.5 years at our institution.
Methods
The study was approved by ethics committee.
Inclusion Criteria: Age 18 years and above undergoing DHS/ Hemiarthroplasty and with full mental capacity.
Exclusion criteria: Patients with no capacity or undergoing Total Hip Replacement or Nailing of femur. The randomisation was done by using the sealed envelopes. The wound review was done on post op days 2, 5, 7, 10 & 14.
Results
516 patients were included in the study. They were divided in to two groups, 252 Hemiarthroplasty and 264 DHS. Average age was 79.48 yrs. (range 31–100 yrs.), 357 Females and 159 males. Total 196 patients were followed up till day 14 and rest of the patients were discharged by the 10th post op day. Out of 516 patients, 278 patients had clips and 238 patients had sub cut monocryl suture for the wound closure.
The average score was 1.20 (range 1–3) for the wounds (the group of 278 patients) closed with clips mainly due to bruising and oozing.
The average score was 0.71(range 0–1) for the wounds (the 238 group of patients) closed with sub cut monocryl mainly due to bruising.
We did not find any significant wound infection in either of these groups.
Conclusion
The final review of our study showed that the wounds closed with sub cut monocryl had less wound healing issues (average score 0.71) as compared to the wounds closed with clips (average score 1.20).
