Comparative study of intramedulary nailing of closed femur fractures in HIV positive and negative patients.
Keetse, Mmakgabo Matthews.
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Introduction This study tested the hypothesis that there is no difference in both short-term infection rates and late implant sepsis and non-union rates between in HIV positive and HIV negative patients treated by reamed, closed femoral nailing for closed femur fractures. Patients and Methods Between February 2011 and December 2012 all patients with femur shaft fractures treated by reamed intramedullary nailing were recruited at a single referral hospital with a high rate of trauma and HIV prevalence. Thirty-two HIV positive patients and 80 HIV negative patients were enrolled and followed up clinically. Other variables included high or low energy injuries, age, AO/ASIF fracture pattern and CD4 counts. They were assessed for wound sepsis using the ASEPSIS method and followed up radiologically to assess for union of their nailed femurs. Follow-up was by telephonic interview to assess for late implant sepsis and non-union. Results There were no cases of early implant sepsis in either the 32 HIV positive or 80 HIV negative patients noted in the clinical and radiological follow up. Only one patient in the HIV positive cohort had a high ASEPSIS score, but this was deemed a superficial infection which resolved on antibiotics. A 3-year telephonic assessment of 32 HIV positive patients and 71 HIV negative patients with implants in situ and was undertaken. No cases of sepsis were found in the HIV group and one case of sepsis in the HIV positive group and this sepsis resolved after nail removal. Interestingly, this was in a patient who was initially HIV negative when nailed and later sero-converted. There were no cases of non-union in the HIV positive group or the HIV negative groups at 3 year follow up. Conclusions This research study found no increased risk of sepsis in closed femoral shaft fractures treated by internal fixation in HIV positive patients and adds to the limited literature regarding long term implant sepsis in HIV positive patients and concludes that there is no apparent increased risk of late, implant sepsis. There does not appear to be an increased non-union rate in HIV positive patients treated by reamed nailing fixation of closed femur fractures.