Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Procedure-specific outcomes of bipolar versus monopolar electrocautery in primary hip and knee arthroplasty: A systematic review and meta-analysis.","authors":"Conor Farrell, Martin S Davey, David O'Sullivan, Colin G Murphy, John F Quinlan, May S Cleary","doi":"10.1016/j.surge.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.surge.2026.10.011","url":null,"abstract":"<p><strong>Background: </strong>Bipolar (BP) electrocautery has been introduced as an alternative to monopolar (MP) electrocautery in arthroplasty, with proposed advantages including reduced blood loss and improved haemostasis. This study aimed to compare peri-operative blood loss and haemoglobin levels associated with bipolar versus monopolar electrocautery in PrimaryTHA and TKA.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed in accordance with PRISMA guidelines. MEDLINE, EMBASE, and Cochrane databases were searched by two independent reviewers. Studies comparing BP and MP electrocautery in primary THA or TKA were included. Meta-analysis was performed using fixed-effect models.</p><p><strong>Results: </strong> Eight RCTs comprising 971 patients (476 bipolar, 495 monopolar) were included; six were suitable for meta-analysis. Pooled THA and TKA analyses showed no significant differences in haemoglobin drop (MD 0.21 g/dL; p = 0.07), total blood loss (MD 5.06 mL; p = 0.57), or length of stay (MD 0.12 days; p = 0.26). Subgroup analysis in TKA showed reduced haemoglobin drop (MD 0.32 g/dL; p = 0.002) and blood loss (MD 89.67 mL; p = 0.03) with BP electrocautery; this was not observed in THA.</p><p><strong>Conclusion: </strong>This meta-analysis found no clinically meaningful advantage of BP over MP electrocautery in primary THA and TKA. Reductions in blood loss and haemoglobin drop in TKA are likely multi-factorial and not clearly attributable to electrocautery type. Routine use of BP electrocautery in primary arthroplasty is not supported.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the potential ethical and legal challenges of transitional care in urological surgery - A tale of two continents.","authors":"F O'Kelly, I Choi, B B McGuire, S O'Meara, K Ebert, W A Farhat","doi":"10.1016/j.surge.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.surge.2026.10.008","url":null,"abstract":"<p><p>Transitional urology services have been shown to be essential in promoting health, reducing morbidity and mortality, and lowering healthcare costs, with no ethical grounds for objection. There is a need for an integrative framework in transitional care, focusing on autonomy, trust, equality, and human rights, as well as to address disparities faced by adolescents with congenital and acquired urological conditions in countries without formalised transitional care. European countries without a formal transition and congenital adult service may find themselves in breach of the European Convention on Human Rights (ECHR) and, where applicable, the EU Charter of Fundamental Rights, due to the principle of primacy, and therefore this cohort is being unjustly discriminated against as both minors and as those with a form of disability. Following the UK's departure from the European Union, the EU Charter of Fundamental Rights no longer applies; however, the ECHR remains incorporated into UK domestic law via the Human Rights Act 1998. In North America, relevant legal protections - including the Americans with Disabilities Act (1990) and the Accessible Canada Act (2019) - create ethical and legal obligations to provide equitable care, though without the same primacy-based enforcement mechanisms as European convention law. In advocating for the establishment of dedicated specialists and tailored services, logistical and ethical challenges must be considered when managing these patients within an under-resourced healthcare system. Addressing these challenges requires multidisciplinary collaboration. By recognising and actively working to overcome these obstacles, healthcare systems can better support individuals with congenital anomalies throughout their lives.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric bone and soft-tissue sarcomas in Ireland: Epidemiology, management and outcomes.","authors":"Timothy McAleese, Ann Marie Delaney, Mohammed Al Salah, Matthew Lee, Gary C O'Toole, Alan P Molloy","doi":"10.1016/j.surge.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.surge.2026.10.004","url":null,"abstract":"<p><strong>Background: </strong>Paediatric bone and soft tissue sarcomas are rare malignancies, that typically require multimodal oncologic therapy and technically demanding surgery delivered within a specialist multidisciplinary team setting. The epidemiology, management and outcomes of paediatric sarcoma in Ireland have not yet been described.</p><p><strong>Methods: </strong>This was an observational study of a consecutive cohort of patients aged <16 years with primary bone or soft-tissue sarcoma managed by Ireland's national sarcoma service over a 10-year period. The epidemiology, management, and outcomes of these patients were reported. The primary outcome was overall survival which was reported using Kaplan-Meier estimates. The factors associated with survival were also analysed.</p><p><strong>Results: </strong>Eighty-eight patients were included, of whom 53.4% (47/88) were male. Osteosarcoma was the most common diagnosis (46.6%, 41/88), followed by Ewing's sarcoma (25%, 22/88). Soft-tissue sarcoma accounted for 25% (22/88). Primary sites most frequently involved the femur (33%, 29/88), tibia (18.2%, 16/88), humerus (15.9%, 14/88) and pelvis (11.4%, 10/88). Metastatic pulmonary disease was present at diagnosis in 33% (29/88) of patients. Seventy-six patients underwent surgery. Limb-salvage endoprosthetic reconstruction was most common at 46.1% (35/76), followed by en bloc tumour resection in 36.8% (28/76) and amputation in 17.1% (13/76). All patients with a diagnosis of primary bone sarcoma received multi-modal chemotherapy guided by a multidisciplinary team. Overall mortality rate was 25% (22/88). Estimated 5-year survivorship was 81.5% for osteosarcoma, 93.3% for Ewing sarcoma, and 90.9% for soft-tissue sarcoma. Mortality was highest when metastatic disease was present at the time of diagnosis (51.7% vs 11.9%, p < .001), (HR 2.81, 95% CI 0.96-8.25; p = .061).</p><p><strong>Conclusions: </strong>The incidence of paediatric sarcoma in Ireland aligns with other European countries. Overall survivorship was relatively high, with metastatic disease at the time of diagnosis associated with lower survivorship. This study provides a benchmark for the current epidemiology and outcomes for children with sarcoma in Ireland.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical effect of Acostream thrombus aspiration device on early acute superior mesenteric artery embolism.","authors":"Yaobo Yang, Xuan Dong, Zhaoyong Yan, Yang Jiao, Yilin Zhao, Yichen Qu, Sipan Chen","doi":"10.1016/j.surge.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.005","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the feasibility, safety and efficacy of Acostream thrombus aspiration device in the treatment of early acute superior mesenteric artery embolism.</p><p><strong>Methods: </strong>A total of 51 patients with ASEAE in our hospital from May 2020 to May 2025 were enrolled, and their clinical data were retrospectively analyzed. According to different surgical methods, 27 cases were treated with Acostream thrombus aspiration device ((PCDT group), 24 cases were treated with catheter thrombolysis (CDT group). Clinical efficacy and surgical complications were observed and evaluated.</p><p><strong>Results: </strong>All patients successfully completed the thrombolysis therapy, the technical success rate was 100%. There was no significant difference in basic data between the two groups (P > 0.05), the intervention time and abdominal pain relief time of Acostream group were shorter than those of catheter-thrombolytic group (1.20 ± 0.08 h vs 78.87 ± 13.30 h 、1.26 ± 0.32 h vs 25.00 ± 3.67 h P < 0.05).</p><p><strong>Conclusion: </strong>For acute superior mesenteric artery embolism, the clinical efficacy of Acostream thrombus aspiration is faster and safer than catheter thrombolysis.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transanal minimally invasive surgery (TAMIS) versus transanal endoscopic microsurgery (TEM) for local excision of rectal neoplasms: A systematic review and meta-analysis.","authors":"Eimear T Kyle, Devin H McCabe, Fiona K Ring, Niall J O'Sullivan, Brian J Mehigan, John Larkin, Paul H McCormick, Dara Kavanagh, Michael E Kelly","doi":"10.1016/j.surge.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.surge.2026.10.006","url":null,"abstract":"<p><strong>Background: </strong>Local excision techniques, including transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), are widely used for selected rectal neoplasms, though direct comparative evidence remains limited.</p><p><strong>Methods: </strong>A PRISMA-guided systematic review and meta-analysis (PROSPERO CRD420251125364) searched MEDLINE, Embase, Scopus, and Cochrane CENTRAL for comparative studies of TAMIS versus TEM/TEO. Primary endpoints were resection quality and a harmonised composite \"poor-quality resection\" endpoint (R1 margin and/or specimen fragmentation). Random-effects meta-analysis used the Hartung-Knapp-Sidik-Jonkman adjustment; certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>Four studies met inclusion criteria (TAMIS n = 341; TEM/TEO n = 409). Pooled estimates showed no difference in positive margins (RR 1.22, 95% CI 0.52-2.85), specimen fragmentation (RR 1.38, 95% CI 0.33-5.78), or the composite poor-quality endpoint (RR 1.24, 95% CI 0.05-28.23; k = 2, wide interval reflecting HKSJ variance inflation at small k), all of very low certainty. Overall 30-day morbidity favoured TAMIS (RR 0.75, 95% CI 0.61-0.93; low certainty). TAMIS was associated with shorter operative duration (MD -36.4 min, 95% CI -46.2 to -26.5; low certainty). Observed length-of-stay differences likely reflected institutional perioperative pathways rather than platform-specific recovery.</p><p><strong>Conclusion: </strong>Low-certainty evidence suggests TAMIS may shorten operative time and reduce 30-day morbidity compared with TEM/TEO. The evidence is very uncertain regarding resection quality, peritoneal violation, and long-term oncologic outcomes. These findings neither establish equivalence nor identify a decisive advantage for either platform; selection should continue to reflect local availability, cost, and surgeon experience. Prospective, ideally randomised, comparative studies with harmonised endpoints and patient-reported functional outcomes are now the priority.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contradictory guidance, divided practice: a national survey of the compression screw in dynamic hip screw fixation.","authors":"Ghulam Dastagir Faisal Mohammed, Ayodele Odedara, Muhammad Murtaza Khan, Jebran Amin, Abu Zer Saeed, Zubair Younis, Gopikanthan Manoharan","doi":"10.1016/j.surge.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.surge.2026.10.005","url":null,"abstract":"<p><strong>Background: </strong>The compression screw is an optional ancillary component of the dynamic hip screw construct. Guidance on whether to use it, and whether to retain or remove it, is contradictory between the AO, the manufacturers and the biomechanical literature, and no clinical study has compared the two. The aim was to establish current UK practice, understanding and training.</p><p><strong>Methods: </strong>A ten-question electronic survey was distributed through Training Programme Directors in all 23 United Kingdom deaneries and through trainee networks, open from 20 April to 19 July 2025. Users were defined from the direct question on frequency of use. Proportions are reported with Wilson 95% confidence intervals and compared using Fisher's exact test. Free text was coded thematically.</p><p><strong>Results: </strong>One hundred responded: 42 junior and 41 senior trainees, 17 consultants. Seventy-four per cent (95% CI 65-82) use the compression screw at least occasionally. Of these, 38 (51%) remove it, 22 (30%) leave it in and 14 (19%) decide case by case, without difference by grade (p = 0.43). Ninety identified on-table compression correctly, yet 40% endorsed the belief that a retained screw prevents further compression on mobilisation. Thirty-seven per cent had no teaching; teaching predicted use (p = 0.0008), not understanding (p = 0.61).</p><p><strong>Conclusion: </strong>There is no consensus on use of the compression screw and practice does not converge with seniority. Teaching appears to transmit practice rather than mechanism. Explicit teaching, and a comparative study of retention versus removal, are warranted.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between consultant presence and clinical outcome for trauma laparotomy - Implications for surgical training.","authors":"Zhenyang Lin, Victor Kong, Daniel Lee, Surya Akash Boppana, Nikilesh Babu, Alice Hung, Howard Wain, Grant Laing, Damian Clarke","doi":"10.1016/j.surge.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.surge.2026.10.001","url":null,"abstract":"<p><strong>Background: </strong>Surgical training relies on graduated levels of responsibility, where incrementally less supervision is required as the trainee progresses. Emergency trauma laparotomy is both a high risk operation and an important training opportunity; a balance must be maintained between ensuring patient safety and allowing trainee surgeons to develop independent competence. This study set out to assess whether consultant presence at trauma laparotomy results in improved outcomes and to develop criteria for consultant attendance.</p><p><strong>Methods: </strong>We retrospectively analysed 1300 trauma laparotomies at a tertiary South African trauma centre, comparing consultant-present (n = 611) and trainee-led (n = 689) cases. Multivariable logistic regression estimated adjusted odds ratios for mortality and complications, controlling for injury severity and physiology.</p><p><strong>Results: </strong>Consultant-present patients were sicker (ISS 13 vs 9, p < 0.001) and more often underwent damage control surgery (27% vs 11%, p < 0.001), with higher crude mortality (11% vs 6%, p < 0.001). After adjustment, consultant presence was not associated with mortality (adjusted OR 1.44, 95% CI 0.91-2.27, p = 0.12) or complications. A residual excess persisted in the highest acuity groups (ISS ≥ 16, adjusted OR 2.35; penetrating trauma, 2.15).</p><p><strong>Conclusions: </strong>Mandating a consultant surgeon at each trauma laparotomy is unnecessary and trainees are capable of safely and effectively performing trauma laparotomy in appropriately selected patients. The presence of a consultant surgeon reflects the acuity and severity of the injury in each individual patient. Whether trainee-led surgery is equally safe in the most severely injured remains unconfirmed.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroneus longus versus hamstring tendon autografts in arthroscopic anterior cruciate ligament reconstruction: A randomised controlled study.","authors":"Arojuraye Soliudeen Adebayo, Salahudeen Abdulfatah Ayokunle, Alabi Ibrahim Abolaji","doi":"10.1016/j.surge.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.009","url":null,"abstract":"<p><strong>Background: </strong>Hamstring tendon autograft is widely used for anterior cruciate ligament (ACL) reconstruction, but concerns persist regarding graft size, harvest duration, and donor-site morbidity. Peroneus longus tendon (PLT) autograft has emerged as a potential alternative. This study compared PLT and hamstring tendon (HT) autografts in arthroscopic ACL reconstruction.</p><p><strong>Methods: </strong>A randomised controlled study was conducted at a tertiary orthopaedic centre. Adults with ACL rupture were allocated to HT (n = 81) or PLT (n = 81) autograft. Primary outcomes included graft harvest time and graft dimensions. Secondary outcomes included the Lysholm knee score, the American Orthopaedic Foot and Ankle Society (AOFAS) score, thigh circumference, and donor-site morbidity. Follow-up was performed at 1, 6, and 12 months.</p><p><strong>Results: </strong>PLT harvest was significantly faster than HT (7.13 ± 2.30 vs 24.37 ± 4.85 min; p < 0.05). PLT grafts were significantly longer and thicker (p < 0.05). Both groups demonstrated substantial improvement in Lysholm scores, with no significant difference at 12 months (p = 0.53). AOFAS scores in the PLT group returned to near-baseline by 6 months. The HT group exhibited significant thigh hypotrophy and one surgical site infection.</p><p><strong>Conclusion: </strong>PLT autograft provided faster harvest, larger graft dimensions, and lower donor-site morbidity while achieving comparable early functional outcomes to HT autograft. PLT represents a reliable alternative graft option for arthroscopic ACL reconstruction.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction, proportion, and pathways.","authors":"Nicola Maffulli","doi":"10.1016/j.surge.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.008","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do peri-operative prophylactic antibiotics reduce pin-site infection after K-wire application in closed fractures? An international prospective cohort study.","authors":"Sohail Nisar, Abhinav Singh, Ryckie Wade, Peter Giannoudis, Hemant Pandit","doi":"10.1016/j.surge.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.006","url":null,"abstract":"<p><strong>Background and purpose: </strong>The role of peri-operative prophylactic antibiotics in preventing pin-site infection after percutaneous K-wire fixation of closed fractures is unclear, and guidance does not address this procedure. This study evaluated whether prophylaxis reduces infection risk in this setting.</p><p><strong>Methods: </strong>International, multicentre, prospective cohort study across 30 hospitals in three countries (United Kingdom, Spain, Greece) from December 2023 to October 2024, including patients with distal radius or supracondylar elbow fractures managed by percutaneous K-wire fixation. Antibiotic administration was at the treating surgeon's discretion, so the comparison was observational. The primary outcome was surgical site infection (SSI) up to two weeks after K-wire removal, with a pre-specified analysis stratified by fracture type.</p><p><strong>Results: </strong>Of 397 submitted cases, 394 were analysed and SSI outcome data were available for 384 (97.5%). Prophylaxis was the dominant practice, given in 342/394 (86.8%). Nine SSIs occurred (2.3%), with similar incidence in the antibiotic and no-antibiotic groups (8/333 [2.4%] vs 1/51 [2.0%]; risk difference +0.4 percentage points, 95% CI -3.7 to +4.6; p = 1.000). Findings were unchanged when stratified by fracture type and after Mantel-Haenszel adjustment. Eight of nine infections involved soft tissue only; no septic arthritis occurred.</p><p><strong>Conclusions: </strong>Despite prophylaxis being given to the large majority of patients, no reduction in SSI was observed. The confidence interval remains compatible with a clinically important effect in either direction, so a type II error cannot be excluded. These data do not support universal routine prophylaxis, but an adequately powered non-inferiority randomised trial is required before practice changes.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}