An observational case series of HIV-positive patients treated with open reduction internal fixation for a closed lower extremity fracture
The purpose of this study was to investigate the influence of immune deficiency status of HIV-positive patients on postoperative complication such as surgical site infection and nonunions. Retrospective observational cohort study: Level III. Level I trauma center. Consecutive adult HIV-positive patients with closed fractures who underwent operative treatment between January 1, 2001 and December 31, 2012. postoperative complication including infection and fracture nonunion. A total of 42 HIV-positive patients with closed fractures who underwent surgical fracture fixation were identified during the 12-year study time window. Of these, 18 patients were excluded due to incomplete medical records (n = 16) or open fractures (n = 2). The remaining 24 patients with closed fracture treated surgically (19 males and 5 females; mean age 45.1 ± 10.5 years; age range 20–67 years) were included in the study. Within a 6-month period from the time of injury, 16 patients had a CD4+ cell count >200 and five patients had a CD4+ cell count <200 (CD4+ cell count was not available in three patients). Twenty-two patients (91.6 %) were on antiretroviral therapy at the time of injury. Only one patient, with associated end-stage renal failure and diabetes mellitus, developed a postoperative infection (4.2 %). All patients achieved fracture union within 180 days postoperatively, without the need for surgical revisions. Our study suggests that HIV infection does not seem to correlate with a higher risk for the development of postoperative complication related to surgical site infection and fracture nonunions after operative fixation of closed fractures.