# Does the type of surgical attire influence surgical site infection rates in intramedullary nailing for proximal femoral fractures? A retrospective analysis

**Authors:** Maud A. M. Vesseur, Timon van der Burg, Erik R. de Loos, Annette M. Pijnenburg, Wouter L. W. van Hemert, Martijn G. M. Schotanus, Bert Boonen, Raoul van Vugt

PMC · DOI: 10.1007/s00423-025-03889-0 · 2025-10-31

## TL;DR

This study found no difference in infection rates when comparing two types of surgical caps used during hip fracture surgeries.

## Contribution

The study provides evidence that surgical cap type does not affect infection rates in intramedullary nailing procedures.

## Key findings

- No significant difference in superficial wound infections between balaclava and skull cap groups.
- No significant difference in deep wound infections between the two surgical attire types.

## Abstract

The aim of the study was to examine whether there is an incidence difference on surgical site infections between surgeons using different surgical attire during intramedullary fixation for proximal femoral fractures.

1,431 patients were included and divided into two groups; surgeons wearing balaclava- or skull caps (490 vs 941). The occurrence of surgical site infection was retrospectively assessed and divided into superficial- and deep wound infections.

The occurrence of superficial wound infections did not differ significantly between the two groups, with three patients in the balaclava and six in the skull cap group (0.6% vs 0.6%, p = 1.00). Similarly, there was no significant difference in the occurrence of deep wound infections between the groups, with one case in the balaclava and eight in the skull cap group (0.2% vs 0.9%, p = 0.18).

This study found no statistically significant difference in the incidence of surgical site infections (including both superficial and deep wound infections) between balaclava caps and skull caps. These results suggest that the type of surgical attire does not have a significant impact on the occurrence of surgical site infections in intramedullary nailing for proximal femoral fractures. Therefore, factors such as cost, and sustainability should be considered when selecting surgical attire. In this context, the skull cap would be the preferred option.

## Full-text entities

- **Diseases:** infection (MESH:D007239), wound infections (MESH:D014946), femoral fractures (MESH:D005264)
- **Chemicals:** balaclava (-)
- **Species:** Homo sapiens (human, species) [taxon 9606]

## Figures

2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12575447/full.md

---
Source: https://tomesphere.com/paper/PMC12575447