Abstract
Background
In 2011 Aird et al published their results of the effects of HIV on early wound healing in open fractures treated with internal and external fixation. The study was conducted between May 2008 and March 2009 and performed in semi-rural area of KwaZulu-Natal, South Africa. These results suggested that HIV is not a contraindication to internal or external fixation of open fractures, as HIV is not a significant risk factor for acute wound implant infection. We present a longer term follow up of this same cohort of patients from the original study.
Methods
From March 2011 to January 2012 we attempted to contact all patients from Airds original study. A simple telephonic questionnaire was obtained from all the patients contacted, regarding possible late sepsis, non-union and implant removal. Patients were requested to visit the outpatient department for a clinical assessment, a repeat HIV test and new X-rays.
Results
Of the initial 133 patients, 27 patients had external fixators, which were removed, leaving 106 patients with implants in situ at the time of follow up. Six patients had died, 4 of AIDS, 1 of a traffic accident and one of community assault. We were able to obtain telephonic questionnaires of 46 patients in total. Of these 46 patients, 31 were seen at a dedicated research clinic for re-assessment
In the initial study, 33 patients were HIV positive. We re-assessed 14 of these HIV positive patients and of these, 1 patient had metal removed for sepsis and 1 patient had a non-union. The remaining 12 patients had implants in situ without sepsis or non-union.
Conclusion
This is the longest follow up to date of the effect of HIV on surgical implants following open fractures. Our results suggest HIV is not a contraindication for internal surgical fixation of open fractures in HIV positive patients with regards to long term sepsis and the risk of non-unions.
THIS RESEARCH IS SUPPORTED BY A RESEARCH GRANT OF THE ROYAL COLLEGE OF SURGEONS
