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.

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: 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.

Background: Antimicrobial resistance complicates the management of skin and soft tissue infections (SSTIs), particularly in low- and middle-income countries where microbiological surveillance remains limited. We compared the microbiological spectrum and antimicrobial resistance patterns of wound-associated SSTIs between tertiary-care hospitals in Ghana and Germany. Methods: This retrospective bicentric cohort study analysed routine microbiological data from 309 patients in Ghana and 294 patients in Germany. 329 bacterial isolates from Ghana and 816 bacterial isolates from Germany were included. Pathogen distribution, antimicrobial susceptibility, and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), third-generation cephalosporin-resistant (3GC-R) Enterobacterales, and carbapenem-resistant Gram-negative bacteria were compared descriptively. Results: The microbiological spectrum differed markedly between the two cohorts. Gram-negative bacteria predominated in Ghana (83.9%), whereas Gram-positive organisms predominated in Germany (62.9%). Escherichia coli, Pseudomonas aeruginosa, and Klebsiella spp. were the leading pathogens in Ghana, while Staphylococcus aureus was the predominant pathogen in Germany. Compared with Germany, Ghanaian isolates exhibited substantially higher resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides. 3GC-R Enterobacterales were identified in 52.8% and 15.6% of evaluable isolates in Ghana and Germany, respectively. Carbapenem resistance among evaluable Gram-negative isolates was detected in 15.2% and 11.2%, respectively. MRSA prevalence (45.2% vs. 4.1%) was also considerably higher in Ghana than in Germany. Conclusions: Wound-associated SSTIs in Ghana and Germany differ substantially in pathogen distribution and antimicrobial resistance profiles. The predominance of Gram-negative pathogens and the high resistance burden observed in the Ghanaian cohort highlight the need for strengthened microbiological surveillance and antimicrobial stewardship. Institution-specific resistance data are essential to optimize empirical antimicrobial therapy across different healthcare settings.

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.