OUTCOME OF OPEN TIBIAL FRACTURES IN HIV POSITIVE PATIENTS

Abstract

The study sought to compare infection and union rates in HIV positive patients sustaining severe open tibial fractures, with those in healthy controls.

In a prospective study, consecutive adult patients with Gustilo grade 2 or 3 open tibial fractures who consented to enter the study were enrolled and treated according to a standard regime. The regime consisted of intravenous antibiotics, emergency wound excision and irrigation, wound left open, fracture stabilisation by external fixation, wound inspection at 48 hours and closure if clinically indicated. 27 patients with 28 fractures entered of whom 7 patients were HIV positive.

At 3 months, 2 of the HIV positive cases had satisfactory wound healing, while 5 were infected. In the HIV negative controls, 17 had satisfactory wound healing while 4 were infected (p=0.020, Fishers exact test).

At 6 months 4 HIV positive patients were united, 3 were ununited. At the same time, 16 HIV negative patients were united, 1 ununited, and 4 lost to follow-up (p=0.059, Fishers exact test).

Open tibial fractures in HIV positive patients are prone to wound sepsis and may show a tendency to delayed or non-union.