Late implant sepsis after fracture surgery in HIV positive patients

Graham, Simon Matthew; Bates, Jane; Mkandawire, Nyengo; Harrison, William J.

doi:10.1016/j.injury.2014.12.015

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…In accordance with literature 8 - 10 , we did not detect any statistically significant difference in the total rate of both surgical and medical complications between HIV-positive and the HIV-negative patients. In the HIV-positive group, one patient underwent two revision surgeries because of implant breakage and a subsequent infection at the surgical site.…”

Section: Discussionsupporting

confidence: 92%

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Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications

Manzotti

MM²,

Schianchi³

et al. 2021

Malays Orthop J

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Introduction: Aging and effect of antiretroviral therapy on bone mass could increase the risk of femoral neck fractures (FNF) in HIV patient. The aim of this study was specifically to determine whether intracapsular FNF in HIV-positive patients are more prone to short-term post-operative complications than similar fractures occurring in HIV-negative patients. Materials and methods: A group of 25 HIV-positive patients with intracapsular FNF were enrolled and matched to HIV-negative patient with similar fractures according to gender, age, a modified Charlson Comorbidity Index (CCI), fracture classification, surgical treatment and time interval between fracture event and surgery. For each group, length of stay, surgical time, early clinical outcomes and short-term surgical and medical complications were compared to determine the impact on the early outcome. Results: At the time of the fracture occurrence, 56% of HIV-positive patients were on antiretroviral therapy and 12% started with therapy in the perioperative period. At three months follow-up, there were no statistically significant differences between the two study groups in length of stay, Harris hip score and total number of early complications. However, a statistically significant increase in urinary tract infections and longer surgical time using hip sliding screw fixation were seen in the HIV-positive group. The poorest post-operative result was seen in a patient who failed to adequately adhere to the HIV therapy protocol. Conclusions: This study failed to show any statistically significant increase in short-term complications or worse clinical outcomes for intracapsular FNF in HIV-positive patients compared to HIV-negative patients to recommend their treatment in dedicated centres.

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Section: Discussionsupporting

confidence: 92%

“…Some authors suggest that HIV-positive patients have higher rates of wound infection and non-union after internal fixation than HIV-negative patients 6 , 7 . Other studies have suggested that HIV infection does not correlate with a higher rate of post-operative infection and fracture non-union 8 - 10 .…”

Section: Introductionmentioning

confidence: 89%

Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications

Manzotti

MM²,

Schianchi³

et al. 2021

Malays Orthop J

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“… 22 Late infection was diagnosed as any late-wound breakdown (>30 days for closed reduction of fractures or >90 days for openly reduced fractures) or sinus formation or unexplained late pain with associated radiological changes consistent with periimplant infection. 23 …”

Section: Methodsmentioning

confidence: 99%

Fracture Healing in Patients With HIV in South Africa: A Prospective Cohort Study

Graham

Maqungo

Laubscher

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Human immunodeficiency virus (HIV) reduces bone mineral density, mineralisation and turnover, and may impair fracture healing.Setting: This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing following trauma.Methods: All adults with acute tibia and femur fractures who underwent intermedullary nailing (IM) for fracture fixation between September 2017 and December 2018, at two tertiary hospitals, were followed for a minimum of 12 months post-operatively. The primary outcome was delayed bone union at 6 months (defined by the radiological union scoring system for the tibia [RUST] score <9), and the secondary outcome was non-union (defined as RUST A C C E P T E Dscore <9) at 9 months. Multivariable logistic regression models were constructed to investigate associations between HIV status and impaired fracture healing.Results: In total, 358 participants, who underwent 395 IM nailings, were enrolled in the study and followed up for 12 months. Seventy-one participants (71/358, 19•8%) were HIV positive (83 IM nailings [83/395], 21.0%). HIV was not associated with delayed fracture healing after IM nailing of the tibia or femur (multivariable odds ratio [OR]: 1•06; 95% confidence interval [CI]: 0•50-2•22). Participants with HIV had a statistically significant lower odds of non-union compared to HIV-negative participants (multivariable OR: 0•17; 95% CI: 0•01-0•92). Conclusions:Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in individuals who are HIV negative, with no increased risk of delayed union or non-union. Funding: This study was funded by a Wellcome Trust Research and Training PhD Fellowship and support from the AOUK foundation.

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“…3 In addition, some authors suggest that implant sepsis may occur after internal fixation, demonstrating that removal of implants in HIV-positive individuals should be considered, 5 , 8 but in another study of 91 HIV-positive patients, Graham concluded that it was safe to perform internal fixation and no increased risk of implant sepsis was detected. 9 Apparently, controversies are common.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the surgical treatment of fracture in HIV positive patients: A clinical study

Zhao²,

Sun³

et al. 2017

Pak J Med Sci

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Objective:To evaluate the incidence of postoperative infection and fracture nonunion as well as the risk factors for postoperative infection in human immunodeficiency virus (HIV) positive patients.Methods:From May 2013 to March 2016, the HIV positive fracture patients treated surgically in orthopaedics department of our hospital were analyzed retrospectively, and fifty HIV negative fracture patients during the same period were selected as control. The clinical data of included patients were reviewed. The incidence of postoperative infection and fracture nonunion were compared between the two groups, and the risk factors for postoperative infection in HIV positive patients were evaluated.Results:The incidence of poor wound healing and incision infection in HIV positive group was higher than that in HIV negative group, but there were no significant differences between the two groups (p>0.05). Multivariable regression analysis demonstrated that HIV clinical category (p<0.05), CD4+T-lymphocyte category (p<0.01) and open fracture (p<0.05) were independent risk factors for postoperative wound infections, but age, gender, operation time, incision type, emergency operation, albumin and lymphocyte count were not (p>0.05). There was no significant difference in the rate of nonunion between the two groups (p>0.05).Conclusion:The incision can be healed, and fracture can be united normally in most of HIV positive patients with fracture, and postoperative wound infections were significantly associated with HIV clinical category, CD4+T-lymphocyte category and open fracture.

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Late implant sepsis after fracture surgery in HIV positive patients

Cited by 13 publications

References 17 publications

Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications

Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications

Fracture Healing in Patients With HIV in South Africa: A Prospective Cohort Study

Analysis of the surgical treatment of fracture in HIV positive patients: A clinical study

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