title: A prospective randomized comparison of two skin closure techniques in acetabular fracture surgery.
abstract: BACKGROUND
  Recent publications have shown an infection rate of 5-7 % for acetabular fractures treated with the Kocher-Langenbeck (K-L) approach. Using metallic staples to close hip skin incisions has been considered the gold standard. The purpose of this study was to answer the following: (1) will closure of a K-L incision after acetabular fracture surgery with a running subcuticular monocryl suture, then sealing the wound with 2-octyl cyanoacrylate (OCA), result in a lower infection rate compared to metallic staple closure? (2) Do incisions closed with subcuticular monocryl and OCA exhibit decreased drainage? (3) Is there a cost difference between these two methods?
  
  
  METHODS
  In a prospective clinical study, 103 patients with acetabular fractures treated using the K-L approach were randomized into two groups: skin closure with metallic staples (n = 52) versus subcuticular running monocryl suture sealed with OCA (n = 51).
  
  
  RESULTS
  Two postoperative deep infections (4 %) in the staples group required multiple debridements; no infections developed in the OCA group. However, there was no statistical difference between the groups, (p = 0.495). There was a statistically significant difference (p = 0.032) comparing days from surgery to a dry incision favoring OCA (4.2 versus 5.85 days). The patient charge was approximately $900 greater on average in the OCA group due to the increased time in the operating room required for the subcuticular closure.
  
  
  CONCLUSIONS
  Closure with OCA and subcuticular monocryl showed no clinical disadvantages and appears to have a clinical advantage when compared to standard metallic staple skin closure in acetabular fracture surgery. However, additional patient costs may be incurred.
  
  
  METHODS
  II.
authors.affiliation: Metropolitian Orthopedics, Missouri Baptist Medical Center, 3009 Ballas Road, Suite 105 B, St. Louis, MO, 63131, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mudd
authors.forename: John A
authors.initials: JA
authors.lastname: Boudreau
authors.forename: Berton R
authors.initials: BR
authors.lastname: Moed
mesh_terms: D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D003487:Cyanoacrylates; D004146:Dioxanes; D004322:Drainage; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D017722:Hospital Charges; D006801:Humans; D008297:Male; D061646:Operative Time; D011091:Polyesters; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013537:Sutures; D014014:Tissue Adhesives; D058106:Wound Closure Techniques / Q000191:economics / Q000295:instrumentation*
chemical_list: D003487:Cyanoacrylates; D004146:Dioxanes; D011091:Polyesters; D014014:Tissue Adhesives; C095495:glycolide E-caprolactone copolymer; C100832:octyl 2-cyanoacrylate