title: Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study.
abstract: We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl.
authors.affiliation: Mersey Deanery Orthopaedic Training Programme, Orthopaedic Department, Royal Liverpool University Hospital, Prescot Street, L7 8XP Liverpool, UK.
authors.forename: N E
authors.initials: NE
authors.lastname: Howard
authors.forename: M
authors.initials: M
authors.lastname: Phaff
authors.forename: J
authors.initials: J
authors.lastname: Aird
authors.forename: L
authors.initials: L
authors.lastname: Wicks
authors.forename: P
authors.initials: P
authors.lastname: Rollinson
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000150:complications / Q000276:immunology / Q000503:physiopathology; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000150:complications / Q000276:immunology / Q000503:physiopathology; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: External Fixation; HIV; Human immunodeficiency virus; Internal fixation; Open tibia fractures; Wound Infection