Surgical glove perforation during intramedullary nailing of intertrochanteric fractures

Abstract

Intramedullary nail fixation is a routine procedure for treatment of intertrochanteric fractures. Aseptic technique is vital for reducing postoperative complications, as intraoperative glove perforations increase the risk of surgical site infections. The aim of this study was to determine the incidence of surgical glove perforation during intramedullary nailing of intertrochanteric fractures and to identify surgery-specific steps at risk. A prospective series of 148 short intramedullary nail implantations was analysed. Intraoperative glove perforations and causative events were recorded. All gloves from the scrubbed surgical team were collected and examined for micro- and macroperforations. 1771 gloves were tested. A total of 341 perforations in 309 gloves were detected, resulting in an overall glove perforation rate of 17%. Surgeon experience had no influence on the overall incidence of glove perforations. Usage of the awl and insertion of the proximal locking screw resulted in 33.9% of all detected glove perforations. Perforation rate significantly increased with operative time (p = 0.003). Regular glove changing after surgery-specific risk-steps and during longer surgeries could decrease the rate of glove perforations during intramedullary nailing of intertrochanteric fractures and reduce the risk of potential septic contamination or even disease transmission for both, the surgeon, and the patient.

Fig. 1

Perforation pattern for the surgical team members. Glove perforation patterns for each surgical team member. Percentages are given in relation to each operation team member’s number of perforations.

Fig. 2

Influence of operation side and hand dominance on localization of perforation. Frequency (%) of glove perforations depending of the hand used and in relation to the side of the operated hip.

Fig. 3

Surgical steps leading to glove perforation. Frequency (%) of glove perforations during at-risk steps in surgery.

Fig. 4

Perforation rate in relation to operating time. Total perforation rate per surgery analyzed in different groups depending on the operating time. Count of perforations per surgery is given in the y-axis and operating times grouped in 0–30 min, 31–60 min and longer than 60 min are given on the x-axis. *p < 0.05, **p < 0.005.