Aim. To conduct a systematic review and meta-analysis comparing the development of early and late fracture-related infections (FRI) following closed and open fractures in HIV-positive and HIV-negative patients. Method. A systematic literature search was conducted using MEDLINE through the OVID interface, ProQuest, Web of Science, The Cochrane Library and Scopus. Only studies involving HIV-positive who underwent operative fixation (internal or external) of open or closed fractures, with a HIV-negative control group, were considered eligible. Following eligibility assessment, studies were included with the main outcome of interest being the development of either early or late fracture-related infection at the site of surgery in patients with open and closed fractures. Results. Eleven studies were included (n = 2634). The studies’ follow-up periods were between one and 39 months with an average of 11 months. Three studies were conducted before the introduction of ARV (anti-retroviral) therapy (1994) and two did not involve any patients on ARV's. Across the entire group, for both open and closed fractures, the risk of a fracture-related infection was greater in HIV-positive patients (Odds ratio (OR) = 1.61; 95% CI = 0.93–2.79, p = 0.04). When looking at closed fractures treated operatively, an OR = 4.59 was found in HIV-positive patients in terms of the risk of fracture-related infection (95% CI = 0.30–68.99, p < 0.001). Open fractures showed similar results with an OR of 3.48 in HIV-positive patients (95% CI = 0.55 – 21.99, p < 0.001). Studies performed prior to the widespread introduction of anti-retroviral therapy and/or did not have any patients on antiretroviral therapy showed a greater infection risk in patients living with
Background:. There are multiple risk factors regarding the outcome of open tibia fractures treated with surgical fixation. In this study we have looked at delay to debridement and
Background:. There is limited evidence regarding
Purpose of study. Pin tract infection is a common complication with the use of circular external fixators.
The April 2023 Hip & Pelvis Roundup360 looks at: Do technical errors determine outcomes of operatively managed femoral neck fractures in younger adults?; Single-stage or two-stage revision for hip prosthetic joint infection (INFORM); Fixation better than revision in type B periprosthetic fractures of taper slip stems; Can you maximize femoral head size at the expense of liner thickness?; Plasma D-dimer for periprosthetic joint infection?; How important is in vivo oxidation?; Total hip arthroplasty for HIV patients with osteonecrosis.
Fractures of the ankle are common, and they mostly affect young adults. Wound complications are not uncommon following the fixation of these fractures. This study evaluated the impact of HIV on wound healing after plate osteosynthesis in patients with closed ankle fractures. This is an observational retrospective study of patients operated on at a tertiary level hospital. We reviewed hospital records for patients above 18 years of age who presented with wound breakdown following ankle open reduction and internal fixation. The patients’ hospital records were retrieved to identify all the patients treated for closed ankle fractures and those who developed wound breakdown. Patients with Pilon fractures were excluded. The National Health Laboratory System (NHLS) database was accessed to retrieve the CD4 count, viral load, haematology study results, and biochemistry results of these patients at the time of surgery and subsequent follow-up. The x-rays were retrieved from the electronic picture archiving system (PACS) and were assessed for fracture union at a minimum of 3 months follow-up. We reviewed the medical records of 172 patients with closed ankle fractures treated from 2018 to 2022. Thirty-one (18.0%) developed wound breakdown after surgery, and they were all tested for HIV. Most of the patients were male (58.0%), and the average age of the cohort was 43.7 years (range: 21 years to 84 years). Ten of these patients (32.2%) were confirmed HIV positive, with CD4 counts ranging from 155 to 781. Viral load levels were lower than detectable in 40% of these patients. All patients progressed to fracture union at a minimum of 3 months follow-up. We observed no difference between HIV-positive and HIV-negative patients in terms of wound breakdown and bone healing post-plate osteosynthesis for closed ankle fractures.
Infection of human cartilage with HIV in vivo has not previously been reported. Specimens of articular cartilage taken at postmortem from ten patients who were HIV-positive were examined. Two had AIDS and eight were believed to have stage-2 disease. The standard polymerase chain reaction (PCR) protocol was modified to allow semiquantitative analysis of the samples. Oligonucleotide primers labelled with 32P gamma-ATP were used to detect a segment of HIV DNA and a control DNA gene segment (HLA genome) to estimate the ratio of infected cells. The 32P-labelled PCR products were separated on acrylamide gels and visualised directly by autoradiography and computer densitometry. Infection of human cartilage in vivo was demonstrated in nine of the ten samples in which the PCR analysis was positive. The other did not react sufficiently to produce detectable radiolabelled PCR product despite repeated DNA digestion and extraction. Cartilage infected with HIV could be a potential source of HIV when used in operations.
Highly active anti-retroviral therapy has transformed HIV into a chronic disease with a long-term asymptomatic phase. As a result, emphasis is shifting to other effects of the virus, aside from immunosuppression and mortality. We have reviewed the current evidence for an association between
Abstract. Aim. End-stage arthropathy is a well-known complication of haemophilia, with recurrent haemarthroses leading to joint destruction, deformity, pain, and stiffness. In the knee, this is often treated with total knee arthroplasty (TKA), which can be more challenging in patients with haemophilia (PwH) and associated with poorer outcomes. We conducted a systematic literature review and meta-analysis to determine implant survivorship, functional outcomes and complication rates. Method. A systematic review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting TKA outcomes with Kaplan-Meier survivorship in PwH (PROSPERO registered). Meta-analysis was performed for survivorship and outcomes, and the results were compared to outcomes from the National Joint Registry (NJR). Results. 19 studies, totalling 1187 TKAs (average age 39 years) were reviewed. In PwH, implant survivorship at 5, 10, and 15 years was 94%, 86%, and 76% respectively, whereas NJR reported survivorship for males <55 years was 94%, 90%, and 86%. Survivorship generally improved over the time period studied (1973–2017), but was inversely correlated with
The prevalence of
Aim. Periprosthetic joint infection (PJI) is a major complication of prosthetic implantation and needs a combined surgical and antimicrobial treatment. One-stage revision results usually in similar cure rate than two-stage (around 85–92%), but antibiotic therapy duration is not well established. The aim of study was to evaluate the efficacy of a short six-weeks antibiotic course in hip and knee PJIs after one-stage replacement arthroplasty (RA). Method. This was a retrospective, observational study conducted at Orthopaedic Department of Cochin Hospital, Paris, between 1stJanuary 2010 and 31 December 2015. Inclusion criteria were: age>18 years; clinical/microbiological diagnosis of PJI; one-stage RA; 6-weeks course of antibiotics; follow-up of at least one year. PJIs were classified depending on the delay of infection from implantation as: early(<3 months), delayed(3–24 months), late(>24 months). Pearson's-χ2 and t-tests were used to compare categorical and continuous variables. Results. Fifty patients with PJIs treated with one-stage hip/knee replacement arthroplasty (HRA/KRA) were included, 42 HRA, 8KRA. Median age was 69.3 years (IQR 24.5–97.4), 31 were males. Comorbidities included tumours(18%), polyarthritis(12%), chronic kidney disease (CKD),
Introduction. Pulmonary Tuberculosis (TB) can be detected by sputum cultures. However, Extra Pulmonary Spinal Tuberculosis (EPSTB), diagnosis is challenging as it relies on retrieving a sample. It is usually discovered in the late stages of presentation due to its slow onset and vague early presentation. Difficulty in detecting Mycobacterium Tuberculosis bacteria from specimens is well documented and therefore often leads to culture negative results. Diagnostic imaging is helpful to initiate empirical therapy, but growing incidence of multidrug resistant TB adds further challenges. Methods. A retrospective analysis of cases from the Infectious Disease (ID) database with Extra Pulmonary Tuberculosis (EPTB) between 1. st. of January 2015 to 31. st. of January. Two groups were compared 1) Culture Negative TB (CNTB) and 2) Culture Positive TB (CPTB). Audit number was. Results. 31 cases were identified with EPSTB. 68% (n=21) were male. 55% (n=17) patients were Asian, (19% (n=6) were black and 16% (n=5) were of white ethnicity. 90.4% (n=28) patients presented with isolated spinal TB symptoms. No patient had evidence of HBV/HCV/
We present a case of Mycobacterium avium-intracellulare (MAI) infection of the ankle joint in a patient with
Despite numerous advances in the management of chronic osteomyelitis, many questions remain. To date, no evidence-based guidelines exist in the treatment of chronic osteomyelitis. In essence the aim is to improve quality of life through either a curative or a palliative treatment strategy. The choice of treatment strategy is based on the physiological status of the host. This process of host stratification is, however, complicated by the fact that the definition of a C-host has never been standardized. Purpose;. The aim of the study was to investigate the short term outcome of the treatment of chronic osteomyelitis in adult patients where selection of a management strategy was based on a refined host stratification system. Methods;. A retrospective review was performed of adult patients with chronic osteomyelitis seen over a one year period. In total 116 patients were included in the study. A modified host stratification system was applied, incorporating predefined major and minor criteria, to determine each patient's host status. Results;. A high prevalence of
Septic arthritis has been regarded as rare in haemophiliacs, but its incidence may have increased since
Purpose of study:. To analyse the bacteriological spectrum, identify most appropriate antibiotics for hand infections, and to characterize patterns and sites of hand infections. This information was collected against the background of a high prevalence of HIV infected patients and increasing antibiotic resistance. Description of methods:. This was a prospective, cross-sectional, analytical study done on 66 patients presenting with hand infections at a public hospital from January to June 2009. A standardised treatment protocol was followed in managing these patients. Data was collected from each participant, and laboratory reports were followed up for the identity and antibiotic susceptibility of causative organisms. All patients were counselled for HIV status and consenting participants were tested. Summary of results:. Staphylococcus aureus was the commonest isolate. Results show that Cloxacillin is still an effective first line antibiotic for community acquired hand infections in the absence of immunosuppression. Alternative empiric therapy would be Clindamycin – especially in the B-lactamase intolerant patient.
Introduction. The resurgence of TB worldwide has several underlying causes, but
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with