Abstract
To determine whether HIV seropositivity is a significant risk factor for infection following open fractures of long bones, we undertook a prospective cohort-type analytical study.
We obtained Ethics Committee approval and invited suitable patients (adults with open fractures of long bones) presenting to our institution to participate in the study. Written informed consent was obtained and the patient registered. Baseline blood tests were done (Hb, HIV, Albumin, CD4 count), after which treatment proceeded in the standard manner. At set intervals, patient records were accessed and information captured in a database. Patients were followed up until bony union had occurred.
To date, 50 patients have been recruited to the study. Of these, 19 were followed up until bony union. All but one of these patients was male and the mean age was 34.5 years. Fractures included three femora, two humeri, two radii and 15 tibiae. There were five Gustilo-Anderson grade-I, seven grade-II, six grade-IIIa and three grade-IIIb open fractures. Three of the 19 patients tested positive for HIV (15.8%). Infection occurred in five patients (26.3%), none of whom was HIV-positive. The strongest predictor for infection was the time delay to wound inspection, with mean delays of 56.9 hours and 100.2 hours respectively in patients who did and did not develop infection.
Although our study is small, it suggests that asymptomatic HIV seropositivity is not a significant risk factor for infection following open fractures of long bones. Delayed wound inspection puts patients at increased risk.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
