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McGee DM, Cotter AG. HIV and fracture: Risk, assessment and intervention. HIV Med 2024; 25:511-528. [PMID: 38087902 DOI: 10.1111/hiv.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 11/17/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVES With management of comorbidity in people living with HIV (PLWH) a key component of clinical care, early loss of bone integrity and clinical fracture are recognized as important issues. This review aims to describe the epidemiology of fracture in PLWH, as well as summarizing the relative balance of factors that contribute to fracture. We also aim to describe fracture risk assessment and interventional strategies to modify the risk of fracture in this population. RESULTS Data from recent meta-analyses show that PLWH have significantly more fractures than the general population, with men and injecting drug users at higher risk. Modifiable factors that contribute to fracture risk in this cohort include body mass index (BMI), drug use, concurrent medications, frailty, and hepatitis C virus infection. Relating to antiretroviral therapy, current or ever tenofovir exposure has been identified as predictive of fracture but not cumulative use, and a potentially modest protective effect of efavirenz has been observed. Fracture Risk Assessment Tool scores underestimate fracture risk in PLWH with improved accuracy when HIV is considered a cause of secondary osteoporosis and bone mineral density (BMD) included. CONCLUSION Early consideration of risk, prompting evaluation of modifiable risk factors, frailty and falls risk with bone density imaging and prompt intervention may avert fracture in PLWH. Guidance on screening and lifestyle modification is available in international guidelines. Bisphosphonates are safe and effective in PLWH, with limited data for other agents.
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Affiliation(s)
- D M McGee
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - A G Cotter
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
- UCD Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Republic of Ireland
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Abbas S, Chokotho L, Nyamulani N, Oliver VL. The burden of long bone fracture and health system response in Malawi: A scoping review. Injury 2024; 55:111243. [PMID: 38096746 DOI: 10.1016/j.injury.2023.111243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Fractures pose serious health and socioeconomic consequences for individuals, their families, and societies more broadly. In many low-resource settings, case fatality and long-term sequelae after a fracture remain high due to individual- and system-level barriers affecting timely access to care. This scoping review explored the burden of fractures in Malawi using long bone fracture (LBF) as a case study by examining the epidemiology of these injuries, their consequences, and the accessibility of quality healthcare. Our aim is to not only describe the scale of the issue but to identify specific interventions that can help address the challenges faced in settings with limited resources and healthcare budgets. METHODS A scoping review methodology was adopted with a narrative synthesis of results. We searched five databases to identify relevant literature and applied the "Three Delays" model and the WHO's Building Blocks Framework to analyse findings on the accessibility of fracture care. RESULTS Fractures most often occurred among young males, with falls being the leading cause, constituting between 5 and 35 % of the total burden of injuries. Fractures were typically managed without surgery despite consistent local evidence showing surgical treatment was superior to conservative management in terms of length of hospital stay and bone healing. Poor functional, economic, and social outcomes were noted in fracture patients, especially after conservative treatment. A lack of trust in the health system, financial barriers, poor transport, and road infrastructure, and interfacility transfers were identified as barriers to care-seeking. Factors challenging the provision of appropriate care included governance issues, poor health infrastructure, financial constraints, and shortage of supplies and human resources. CONCLUSIONS To the best of our knowledge, this review represents the first comprehensive examination of the state of LBF and the health system's response in Malawi. The findings underscore the pressing need for a national trauma registry to accurately determine the actual burden of injuries and support a tailored approach to fracture care in Malawi. It is further evident that the health system in Malawi must be strengthen across all six building blocks to address obstacles to equitable access to high-quality fracture care.
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Affiliation(s)
- Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Linda Chokotho
- Malawi University of Science and Technology, Mikolongwe, Malawi
| | | | - Victoria L Oliver
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
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3
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Graham SM, Maqungo S, Laubscher M, Ferreira N, Held M, Harrison WJ, Simpson AH, MacPherson P, Lalloo DG. Is human immunodeficiency virus a risk factor for the development of nonunion?-a case-control study. OTA Int 2023; 6:e251. [PMID: 37780185 PMCID: PMC10538559 DOI: 10.1097/oi9.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/23/2022] [Indexed: 10/03/2023]
Abstract
Objective Human immunodeficiency virus (HIV) infection has been suggested to be associated with an increased risk of the development of nonunion after a fracture. This prospective matched case-control study in South Africa investigated common risk factors, including HIV status, that influence the development of a nonunion after a femur or tibia fracture. Methods Adult participants (cases) with established nonunions of the femur or tibia shaft were recruited over a 16-month period, between December 2017 and April 2019. They were matched for (1) age; (2) sex; (3) fracture site; and (4) fracture management type, with "control" participants who progressed to fracture union within 6 months of injury. All participants were tested for HIV. Multivariable logistic regression models were constructed to investigate associations between known risk factors for the development of nonunion and impaired fracture healing. Results A total of 57 cases were matched with 57 "control" participants (44/57 male, 77.2% vs. 13/57 female, 22.8%, median age 36 years). HIV status was not associated with the development of nonunion after the management of tibia and femur fractures, on both univariate (odds ratio, 0.40; confidence interval, 0.10-1.32; P = 0.151) or multivariable (odds ratio, 0.86; confidence interval, 0.18-3.73; P = 0.831) analysis. No other confounding factors were shown to have any statistically significant impact on the odds of developing nonunion in this study cohort. Conclusion This study demonstrates that HIV does not seem to increase the risk of the development of nonunion and HIV-positive individuals who sustain a fracture can be managed in the same manner as those who are HIV negative.
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Affiliation(s)
- Simon Matthew Graham
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, UK
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Sithombo Maqungo
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Orthopaedic Research Unit (ORU), University of Cape Town, Cape Town, South Africa
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Maritz Laubscher
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Orthopaedic Research Unit (ORU), University of Cape Town, Cape Town, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa
| | - Michael Held
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Orthopaedic Research Unit (ORU), University of Cape Town, Cape Town, South Africa
| | | | | | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK; and
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Are deep infections that present before and after 90 days from orthopaedic trauma different? An analysis of the validity of the recent change in CDC criteria for infections. Injury 2022; 53:912-918. [PMID: 34732287 DOI: 10.1016/j.injury.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In 2016, the Centers for Disease Control and Prevention (CDC) changed the time frame for their definition of deep surgical site infection (SSI) from within 1 year to within 90 days of surgery. We hypothesized that a substantial number of infections in patients who have undergone fracture fixation present beyond 90 days and that there are patient or injury factors that can predict who is more likely to present with SSI after 90 days. METHODS A retrospective review yielded 452 deep SSI after fracture fixation. These patients were divided into two groups-those infected within 90 days of surgery and those infected beyond 90 days . Data were collected on risk factors for infection. Univariate and multiple logistic regression analyses were performed to compare the two groups. A randomly selected control group was used to build infection prediction models for both outcomes. The two outcomes were then modelled against each other to determine whether differences in predictors for early versus late infection exist. RESULTS Of the 452 infections, 144 occurred beyond 90 days (32% [95% CI, 28%-36%]). No statistically significant patient factors were found in multivariable analysis between the early and late infection groups. The need for flap coverage was the only injury characteristic that differed significantly between groups, with patients in the late infection group more likely to have needed a flap. When modelled against the control group and directly comparing the two models, predictors for early infection include male sex and fractures of the pelvis, acetabulum, or hip, whereas predictors of late infection include hepatitis C and/or human immunodeficiency virus (HIV) and admission to the intensive care unit (ICU). CONCLUSION Use of the recent CDC definition will underestimate the rate of actual postoperative infections when applied to orthopaedic trauma patients. Hepatitis C and/or HIV and ICU admission are predictors of late infection, whereas male sex and pelvis, acetabulum, or hip fractures are predictors of early infection. Patients who receive flap coverage may be more likely to present with late infection.
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Manzotti A, Larghi MM, Schianchi A, Grassi M, Pullen C, Cerveri P. Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications. Malays Orthop J 2021; 15:65-70. [PMID: 34966497 PMCID: PMC8667258 DOI: 10.5704/moj.2111.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- A Manzotti
- Department of Orthopaedic and Trauma, Luigi Sacco University Hospital, Milan, Italy
| | - M M Larghi
- Department of Orthopaedics, University of Milan, Milan, Italy
| | - A Schianchi
- Department of Orthopaedics, University of Milan, Milan, Italy
| | - M Grassi
- Department of Orthopaedic and Trauma, Luigi Sacco University Hospital, Milan, Italy
| | - C Pullen
- Department of Orthopaedics, The Royal Melbourne Hospital, Victoria, Australia
| | - P Cerveri
- Department of Bioengineering, Politecnico di Milano, Milan, Italy
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Graham SM, Maqungo S, Laubscher M, Ferreira N, Held M, Harrison WJ, Simpson AH, MacPherson P, Lalloo DG. Fracture Healing in Patients With HIV in South Africa: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2021; 87:1214-1220. [PMID: 33990496 PMCID: PMC8263144 DOI: 10.1097/qai.0000000000002720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV reduces bone mineral density, mineralization, 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 after trauma. METHODS All adults with acute tibia and femur fractures who underwent intermedullary (IM) nailing for fracture fixation between September 2017 and December 2018, at 2 tertiary hospitals, were followed up for a minimum of 12 months postoperatively. The primary outcome was delayed bone union at 6 months (defined by the radiological union scoring system for the tibia score <9), and the secondary outcome was nonunion (defined as radiological union scoring system for the tibia score <9) at 9 months. Multivariable logistic regression models were constructed to investigate the 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 of the 358 (19.8%) participants were HIV-positive [83/395 (21%) IM nailings]. HIV was not associated with delayed fracture healing after IM nailing of the tibia or femur (multivariable odds ratio: 1.06; 95% confidence interval: 0.50 to 2.22). HIV-positive participants had a statistically significant lower odds ratio of nonunion compared with HIV-negative participants (multivariable odds ratio: 0.17; 95% confidence interval: 0.01 to 0.92). CONCLUSIONS Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in HIV-negative individuals, with no increased risk of delayed union or nonunion.
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Affiliation(s)
- Simon M. Graham
- Institute of Population Health Data Science, University of Liverpool, Liverpool, United Kingdom;
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom;
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa;
| | - Sithombo Maqungo
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa;
- Division of Global Surgery, Orthopaedic Research Unit (ORU), University of Cape Town, Cape Town, South Africa;
| | - Maritz Laubscher
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa;
- Division of Global Surgery, Orthopaedic Research Unit (ORU), University of Cape Town, Cape Town, South Africa;
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa;
| | - Michael Held
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa;
- Division of Global Surgery, Orthopaedic Research Unit (ORU), University of Cape Town, Cape Town, South Africa;
| | - William J. Harrison
- Institute of Population Health Data Science, University of Liverpool, Liverpool, United Kingdom;
- Department of Orthopaedic and Trauma Surgery, Countess of Chester Hospital, Chester, United Kingdom;
| | | | - Peter MacPherson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - David G. Lalloo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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A tale of three pandemics: Shining a light on a hidden problem. Surgeon 2021; 20:231-236. [PMID: 34167911 PMCID: PMC9300845 DOI: 10.1016/j.surge.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
An “epidemic” is an event in which a disease, infectious or non-infectious, is actively spreading within a population and designated area. The term “pandemic” is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. The global response to the COVID-19 pandemic has not been seen since the outbreak of Human Immunodeficiency Virus in the early eighties. But there is another unseen pandemic running alongside the current COVID-19 pandemic, which affects a vast number of people, crossing international boundaries and occurring in every single country worldwide. The pandemic of traumatic injuries. Traumatic injuries account for 11% of the current Global Burden of Disease, resulting in nearly 5 million deaths annually and is the third-leading cause of death worldwide. For every trauma-related death, it is estimated that up to 50 people sustain permanent or temporary disabilities. Furthermore, traumatic injuries occur at disproportionately higher rates in low- and middle-income countries, with approximately 90% of injuries and more than 90% of global deaths from injury occurring these countries. Injuries are increasing worldwide, crossing international boundaries and affecting a large number of people, in the same manner Human Immunodeficiency Virus did in the 1980's and COVID-19 is today. The tremendous global effort to tackle the COVID-19 and Human Immunodeficiency Virus pandemics has occurred whilst ignoring the comparable pandemic of injury. Without change and future engagement with policy makers and international donors this disparity is likely to continue.
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Brennan C, Laubscher M, Maqungo S, Graham SM. Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery. World J Orthop 2021; 12:169-177. [PMID: 33816143 PMCID: PMC7995343 DOI: 10.5312/wjo.v12.i3.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is little research investigating how human immunodeficiency virus (HIV) affects outcomes in orthopaedic surgery. With advances in treatment, HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.
AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.
METHODS A search of the Web of Science database was carried out, identifying any articles relating to HIV published in orthopaedic journals. These were assessed for geographic origin and level of evidence.
RESULTS Of 48.7% of orthopaedic journals listed on the Web of Science database had published articles relating to HIV. There were 168 articles about HIV in orthopaedic journals with only 40.5% (n = 68) published in the time frame we analysed (January 2007 to September 2017). Very few articles came from low-income countries and any articles published from that setting were collaborations. All of the articles were low level of evidence.
CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV, particularly research from low-income countries, where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.
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Affiliation(s)
- Ciaran Brennan
- Department of Orthopaedics, Royal Cornwall Hospital, Truro TR13LQ, United Kingdom
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Sithombo Maqungo
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Simon Matthew Graham
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
- Institute of Population Health Sciences, University of Liverpool, Liverpool L97AL, United Kingdom
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospitals Trust, Liverpool L97AL, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L97AL, United Kingdom
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Xu G, Zhao J, Sun J, Liu Y. Analysis of the surgical treatment of fracture in HIV positive patients: A clinical study. Pak J Med Sci 2017; 33:1449-1453. [PMID: 29492076 PMCID: PMC5768842 DOI: 10.12669/pjms.336.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Guangyong Xu
- Guangyong Xu, Department of Dermatology, Qingdao No.6 People's Hospital, Qingdao, 266033, China
| | - Juan Zhao
- Juan Zhao, Department of Dermatology, Qingdao No.6 People's Hospital, Qingdao, 266033, China
| | - Jie Sun
- Jie Sun, Department of Orthopaedics, Zhangqiu Hospital of Traditional Chinese Medicine, Jinan, 250200, China
| | - Yizong Liu
- Yizong Liu, Department of Orthopaedics, Qingdao No.6 People's Hospital, Qingdao, 266033, China
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Fracture management in HIV positive individuals: a systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 40:2429-2445. [PMID: 27655034 DOI: 10.1007/s00264-016-3285-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV) infection could potentially play an important role in the management of fractures as they have been shown to affect fracture healing and the post-operative risk of implant sepsis. METHODS A systematic review of the relevant literature was performed on PubMed and Scopus databases. Twenty-six studies were identified, critiqued and analysed accordingly. No randomised controlled trials were identified. RESULTS HIV positivity was not shown to influence an individual's risk of early wound infection in operatively managed closed fractures. The rate of pin track infection in open injuries managed with external fixators was low. However, in open injuries managed with internal fixation, early wound infection rates were increased in the HIV-positive population compared to HIV-negative individuals. Regarding late implant infection, in closed fractures there appeared to be no increased risk of infection but there is limited evidence for open injuries. Additionally, further evidence is needed to establish if the rate of union in both open and closed fractures are influenced by HIV status. CONCLUSION Overall, no evidence was found to suggest that surgical management of fractures in the HIV population should be avoided, and fixation of closed fractures in the HIV population appeared to be safe. The effect of anti-retroviral therapy is unclear and this should be further researched. However, based on the limited evidence, caution should be taken in the management of open fractures due to the potentially increased infection risk. The impact of anti-retroviral therapy on the outcomes of surgery needs further evaluation.
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Pretell-Mazzini J, Subhawong T, Hernandez VH, Campo R. HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes. J Bone Joint Surg Am 2016; 98:775-86. [PMID: 27147691 DOI: 10.2106/jbjs.15.00842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤Advances in combined antiretroviral therapy (cART) in recent years have transformed HIV infection into a chronic disease when treatment is available, increasing a patient's life expectancy and the chances that orthopaedic surgeons will encounter such patients in their clinical practice.➤Musculoskeletal manifestations in patients with HIV infection are common and sometimes are the initial presentation of the disease. Knowledge about neoplasms and associated conditions affecting muscle, bones, and joints is essential for successful management.➤Since the advent of cART, total joint arthroplasty has been shown to be a safe procedure; however, perioperative infection is still a small risk in patients with uncontrolled viral loads or CD4 counts of <400 cells/mm(3).➤With regard to trauma surgery, the rates of early and late infection around implants, as well as union rates, are comparable with those in the HIV-negative population; however, there is an increased risk of pulmonary, renal, and infectious or septic complications in the polytrauma setting.➤Factors such as CD4 count, nutritional status, cART therapy, viral load count, and other comorbidities (hemophilia, infection among intravenous drug users, etc.) should be considered when treating these patients in order to optimize their clinical outcomes.
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Affiliation(s)
- Juan Pretell-Mazzini
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Ty Subhawong
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Victor H Hernandez
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Rafael Campo
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
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