Abstract
Introduction
HIV is known to affect many of the processes involved in fracture healing. Recent work has suggested that CD4 cells may act as suppressor in the regulation of fracture healing. There are no clinical studies looking at fracture healing in patients with open fractures in these patients.
Study question
Is there an association between HIV and risk of non union in open fractures treated with surgical stabilisation.
Methods
This was a prospective observation cohort study. All open fractures treated with surgical fixation, presenting to the study hospital over a 9 month period, were included. Non union was the primary outcome. 133 patients (33 HIV positive) with 135 open fractures fulfilled the inclusion criteria.
Results
Exposed and unexposed populations were broadly similar. The risk of non union was 15% in HIV positive patients and 4% in HIV negative patients (Risk Ratio= 4, p =0.04).
Discussion
The data suggests that HIV may adversely affect fracture healing in open fractures treated with surgical stabilisation. Treatment of these patients needs to account for the high non union rate. This study population provides an interesting insight into how modulation of the immune system affects fracture healing.
