Lisa Fiona Roder

Purpose: Kirschner wires (K-wires) are widely used for fracture fixation in paediatric trauma surgery. Although infectious complications are uncommon, they remain clinically relevant. Subcutaneous burial of K-wires has been proposed to reduce the risk of infection, but robust data from large paediatric cohorts remain limited. This study aimed to evaluate infectious and non-infectious complications following routine use of buried K-wires in children. Methods: In this retrospective cohort study, paediatric patients (≤ 18 years) who underwent fracture fixation with routinely buried K-wires at a Level I trauma centre between January 2005 and November 2025 were included. Only patients with complete follow-up, including radiographic assessment and wire removal at the study institution, were analysed. The primary outcome was postoperative infection related to K-wire fixation. Secondary outcomes included non-infectious wound complications, reoperations, and fracture healing. Results: A total of 634 patients with a mean age of 10.2 ± 4.2 years were included; 96.8% sustained upper-extremity fractures. One superficial infection occurred (0.16%; 95% CI 0.00–0.88%), with no cases of deep infection or osteomyelitis. Secondary skin perforation without infection was observed in 8.36%, and minor wound-healing disturbances in 0.32%. No infection-related reoperations were required, and all fractures healed radiographically. Conclusions: Routine subcutaneous burial of K-wires in paediatric fracture fixation was associated with an exceptionally low rate of infectious complications and no cases of osteomyelitis in this large retrospective cohort. However, secondary skin perforation occurred in 8.36% of patients, and planned wire removal under anaesthesia represents an additional procedural burden. Given the predominance of upper-extremity fractures and the absence of an exposed-wire control group, these findings should be interpreted within the studied population and do not establish superiority over exposed K-wires.

Introduction: Pediatric polytrauma remains a major cause of morbidity and mortality worldwide. Owing to age-specific anatomical and physiological characteristics, children are particularly vulnerable to traumatic brain injury (TBI), which frequently represents the most severe component of polytrauma. This study aimed to evaluate injury mechanisms, injury patterns, treatment strategies, complications, and outcomes in pediatric polytrauma patients treated at a tertiary trauma center. Methods: A retrospective single-center cohort study was conducted including pediatric patients (< 18 years) with polytrauma, meaning with an Injury Severity Score (ISS) ≥ 16, treated at the University Hospital Bonn between 2023 and 2025. Demographic data, injury mechanisms, injury patterns, ISS, Maximum Abbreviated Injury Scale (MAIS) scores, surgical interventions, intensive care unit (ICU) treatment, complications, and discharge outcomes were analyzed. Correlations between head MAIS, ISS, age, and length of hospital stay were assessed using Spearman’s rank correlation coefficient, while differences in ISS between injury mechanisms were evaluated using the Kruskal–Wallis test. Results: Thirty-two pediatric patients were included. The median age was 13.5 years (range 2–17 years), and 50% were female. Traffic accidents were the predominant mechanism of injury (75%), followed by falls from heights greater than 3 m (12.5%). Head trauma was the most common injury pattern, including skull fractures (34.4%), subarachnoid hemorrhage (28.1%), subdural hematoma (25.0%), and epidural hematoma (9.4%). Thoracic, abdominal, pelvic, and extremity injuries were also frequently observed. Fifteen patients (46.9%) required surgical intervention. The median ICU stay was 3 days (range 0–69 days). Complications occurred in five patients (15.6%) and included meningitis, aseptic bone necrosis, epidural rebleeding, soft tissue infection, and pulmonary complications. No in-hospital mortality was observed. Most patients (84.4%) were discharged directly home, while 6.3% required inpatient rehabilitation and 9.4% were transferred to another hospital. No significant correlations were found between head MAIS and length of hospital stay (ρ = 0.28, p = 0.127), head MAIS and ISS (ρ = 0.07, p = 0.714), ISS and hospitalization duration (ρ = 0.10, p = 0.581), or age and head MAIS (ρ = 0.03, p = 0.883). Conclusion: TBI represented the predominant injury burden and was associated with the most complex clinical courses. Despite the severity of injuries, outcomes were generally favorable, characterized by low complication rates, absence of in-hospital mortality, and a high proportion of patients discharged home. These findings emphasize the importance of specialized multidisciplinary trauma care, neurosurgical expertise, and pediatric intensive care management in severely injured children. Larger multicenter studies with long-term follow-up are warranted to further identify predictors of outcome and optimize pediatric polytrauma care.

Background: Hand osteomyelitis is an uncommon but potentially devastating infection associated with prolonged treatment, repeated surgical interventions, and risk of amputation. Owing to its rarity, evidence regarding prognostic factors and optimal management remains limited. This study aimed to evaluate the clinical characteristics, microbiological findings, treatment strategies, and outcomes of patients with hand osteomyelitis, with particular emphasis on the association of admission inflammatory markers, immunosuppression, and preoperative magnetic resonance imaging (MRI). Methods: A retrospective single-center cohort study was performed over a 11-year period at a tertiary referral hospital. Patients with clinically and/or histopathologically confirmed hand osteomyelitis were identified using ICD-10-GM codes. Demographic characteristics, etiology, microbiological and histopathological findings, laboratory parameters, imaging, surgical treatment, antibiotic therapy, and length of hospital stay were reviewed. Correlations between admission C-reactive protein (CRP), leukocyte count, number of surgical procedures, and hospital stay were analyzed using Pearson’s correlation coefficient. Results: Fourteen patients were included (mean age, 53.7 years; 64.3% female). Osteomyelitis predominantly affected the distal phalanx (92.9%). Immunosuppression or immunocompromising comorbidities were present in 64.3% of patients. Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Streptococcus pyogenes were the most frequently isolated pathogens, while immunosuppressed patients exhibited more polymicrobial infections. The mean admission CRP was 87.8 mg/L and was markedly higher in immunosuppressed than in non-immunosuppressed patients (128.5 vs. 14.6 mg/L). Amputation was required in 78.6% of patients, with a mean of 3.3 surgical procedures per patient. Admission CRP is associated with both length of hospital stay (r = 0.61) and number of surgical procedures (r = 0.73), whereas leukocyte count showed only weak correlations. Patients who underwent MRI had a shorter mean hospital stay than those without MRI (13.4 vs. 19.6 days). The mean duration of antibiotic therapy was 29.3 days. Conclusions: In this small cohort, admission CRP showed a potential association with disease severity in hand osteomyelitis, with higher levels observed in patients requiring more extensive surgical treatment and longer hospitalization. MRI was associated with a shorter hospital stay, suggesting a possible role of early advanced imaging in facilitating timely diagnosis and treatment planning. Immunosuppressed patients tended to exhibit higher inflammatory markers and more frequently polymicrobial infections, although these findings should be interpreted cautiously given the limited sample size. Overall, these observations are exploratory and require confirmation in larger, preferably prospective studies.

Objective: Traumatic dislocation and fracture–dislocation of the hip are rare and severe injuries often associated with high-energy trauma. Early recognition and rapid, stable reduction are essential for successful treatment; otherwise, this type of injury is associated with poor functional outcomes and high rates of complications such as avascular necrosis. This retrospective study aims to describe and analyze long-term outcomes and survival rates after a hip dislocation. Methods: Between 2008 and 2021, all patients with traumatic hip dislocation who were treated in a Level I Trauma Center were retrospectively assessed and analyzed. During the follow-up examination, two experienced surgeons carried out a clinical follow-up examination and evaluated the available X-ray images. Anterior and posterior fracture–dislocations and femoral head fractures were classified according to Stewart and Milford’s and Pipkin’s classification system, respectively. All patients were followed up using the Harris Hip Score (HHS) and Lequesne score. Results: Forty-four (38 male and 6 female) patients with a mean age of 46.02 (±19.48) years were included. The average follow-up period was 45.69 (±45.69) months. Traffic accidents were the main cause of traumatic dislocation in this series, accounting for 75% of all cases. Associated injuries were noted in 28 cases. Twenty-three and 21 patients were treated with closed and open reduction, respectively. Isolated hip dislocations without bony involvement according to Stewart and Milford type 1 occurred in five cases. Type 3 injuries were most common, followed by type 4 injuries. This study found that the type of reduction and the trauma mechanism are not significant factors in long-term prognosis (p = 0.463). Thirteen patients had subjective excellent or good results in the HHS and Lequesne score. Late post-traumatic osteoarthritis of the hip developed in 10 patients (22.7%). Patients received a hip replacement at 20.7 months (1–102) months. Thus, after 2 years, implantation of a hip prosthesis due to post-traumatic coxarthrosis was necessary in 22.7% of all cases. The type of hip dislocation classified according to Stewart and Milford had no significant influence on the implantation of a hip prosthesis. Conclusions: Excellent or good results in HHS were obtained in patients with early, stable, and accurate reduction by closed or open methods. After 2 years, 22.7% of the patients needed a total hip replacement.

Background/Objectives: Hand phlegmons are rapidly progressive bacterial soft-tissue infections that may lead to severe functional impairment, repeated surgical interventions, and prolonged hospitalization if diagnosis and treatment are delayed. Although Gram-positive skin flora are considered the predominant pathogens, microbiological findings and clinical severity may vary considerably depending on the extent of infection and host factors. Methods: This single-center retrospective study analyzed 100 patients surgically treated for hand phlegmons at a university hospital between 2020 and 2025. Clinical data included demographics, portal of entry, microbiological findings, inflammatory markers, antibiotic therapy, number of surgical procedures, and length of hospital stay. Pathogens were classified according to Gram stain characteristics, and statistical analyses were performed using nonparametric methods and correlation analyses. Results: The cohort consisted of 69 male and 31 female patients with a mean age of 50.5 ± 20.9 years. Mean hospital stay was 12.9 days (range 1–77), and patients underwent an average of 2.18 surgical procedures (range 0–11). Wounds and bite injuries represented the most common portals of entry, although many cases lacked a clearly identifiable cause. Microbiological cultures were negative in 62% of cases. Among positive cultures, Gram-positive organisms predominated (84.2%), with Staphylococcus aureus and Streptococcus pyogenes representing the most frequent pathogens. MRSA was detected in three patients and was associated with significantly more surgical procedures (p = 0.04) and a tendency toward prolonged hospitalization. Admission CRP levels differed significantly according to Gram stain classification (p = 0.008) and correlated positively with both length of hospital stay (r = 0.431, p < 0.001) and number of surgical interventions (r = 0.272, p = 0.006). Patients with microbiologically confirmed infections required significantly more operative procedures than patients without pathogen detection (p < 0.001). Empiric antibiotic therapy primarily consisted of ampicillin/sulbactam, cefuroxime, and clindamycin, followed by oral therapy with amoxicillin–clavulanate or clindamycin. Conclusions: Hand phlegmons remain clinically challenging infections characterized by heterogeneous presentation, frequent culture-negative findings, and substantial surgical burden. Gram-positive pathogens continue to predominate, while resistant organisms such as MRSA may be associated with more complex clinical courses. Elevated inflammatory markers at admission correlate with prolonged hospitalization and increased operative requirements, suggesting their potential value as indicators of disease severity. Early diagnosis, prompt surgical debridement, and individualized antimicrobial therapy remain essential for infection control and preservation of hand function.

Objective: Femoral head fractures are rare and severe injuries often associated with high-energy trauma. Early recognition and rapid, stable reduction are essential for successful treatment to prevent complications and morbidity. This retrospective study aims to describe and analyze long-term outcomes and survival rates of the femoral head after a Pipkin fracture. Methods: Between 2012 and 2021, all patients with a femoral head fracture who were treated in a Level I Trauma Center were assessed and analyzed. Two examiners performed a physical examination and radiological control of patients and called the patients for a final follow-up. Anterior and posterior fracture-dislocations and femoral head fractures were classified according to Pipkin’s classification system. The functional outcome was assessed using the Harris Hip Score (HHS). Results: Over a 10-year period, n = 15 patients were diagnosed with a femoral head fracture. All patients were male; the average age at admission was 41.3 years. The mean follow-up was 43.7 months ± 46 months. No complications occurred in three patients (20%). Twelve patients had complications. The most common complications were nerve lesions and posttraumatic osteoarthritis. Regarding the outcome, no data were available for two patients; one patient died, and two of four patients remained with a Girdlestone resection arthroplasty at the follow-up. The mean score in HHS was 76.69 ± 20.3 (mean ± standard deviation). Conclusions: An overall complication rate of 80% was observed; however, functional outcomes were generally moderate at final follow-up. These findings highlight the considerable risk of complications associated with femoral head fractures, particularly nerve injury and posttraumatic osteoarthritis. Notably, six of 15 patients no longer retained their native hip joint at the time of assessment. The study is a Level 2b study.

Objective: The current gold standard for detection of implant-related infections is the intraoperative collection of tissue samples. However, false-negative results frequently occur, particularly in infections caused by biofilm-forming bacteria. As a complementary method, sonication has therefore been established for detecting implant-associated infections, especially in periprosthetic joint infections. In trauma surgery, this technique is still rarely used. The aim of this study is to evaluate the diagnostic significance of sonication after osteosynthesis. Methods: A retrospective single-center analysis was conducted on all patients who underwent plate osteosynthesis removal between 1 January 2019, and 1 May 2021, with both sonication and intraoperative tissue sampling performed. Patients with inlying arthroplasties or nail-less osteosynthesis systems were excluded. Pre- and postoperative infection parameters (leukocytes, CRP) were recorded, and preoperative clinical findings were used to classify suspected infection. Results: A total of 57 patients (30 men, 27 women; mean age 57.6 years, range 12–91) were included. The mean treatment duration was 20.1 days (range 1–152). Sonication was positive in 33 patients, tissue samples in 28, with 31 cases (54%) showing concordant results. In cases with preoperative suspicion of infection, sonication was positive in 21 of 26 cases (80.7%) and tissue samples in 18 of 26 (69.2%), whereas without suspicion, positivity rates were 38% and 31%, respectively. Sonication and tissue results matched in 14 of 26 cases; in the remainder, results were different or incomplete. Preoperative CRP elevation and the presence of an infection membrane influenced sensitivity: sonication generally detected more bacteria (59–81%) than tissue samples (49–73%), though discrepancies remained. Conclusions: Sonication represents a valuable complementary method for detecting implant-related infections. Due to its high sensitivity but limited specificity, it should not be used as a standalone diagnostic method.