Introduction and Aims: The rate of wound infection for HIV positive patients, range from 0–33% for closed fractures to 72–80% for compound fractures. For the outcome at our institute, I undertook to study the rate of surgical wound infection in HIV positive patients undergoing unreamed intramedullary fixation for acute fractures.

Method: A prospective single blind study involving 45 patients, who sustained acute fractures of the femur and/or tibia were treated with unreamed intramedullary nails at Durban’s Metropolitan hospitals during April 2002 to June 2003. Eighteen patients were HIV positive with a mean age of 29 years (20–47) compared to 28.5 years (15–56) amongst the HIV negative. There were six and three females in HIV positive and negative groups respectively. Motor vehicle accidents involving pedestrians and gunshot injuries accounted for the majority of the fractures. Although all of the patients were asymptomatic prior to injury, fourteen had associated injuries.

Results: The mean follow-up was 7.3 months (1–14). Following discharge from hospital, patients were seen at two and six weeks, three, six, nine, and 12 months post-operatively. Amongst patients with closed fractures, nine were HIV positive, seven with femur and two with tibia fractures and amongst the HIV negative group 12 patients had femur and seven tibia fractures. Three of the HIV positive patients had compound fracture tibia, each with a Gustilo type II, type IIIA and type IIIB fracture, while four HIV negative patients with, two each of grade II and grade IIIB fracture tibia. Amongst the six HIV positive patients who had compound fractures of the femur one had a grade I, two grade II, two grade IIIA and two grade IIIB fractures. Four HIV negative patients had compound femoral fractures, three with grade II and one grade IIIA. Two patients had wound infection, at one week a HIV positive male with a grade IIIA fracture of the femur and a HIV negative female at two weeks with a grade IIIB fracture of the tibia, resulting in an infection rate 5.5% and 3.7% for the HIV positive and HIV negative patients respectively. This difference was not statically significant (p=0.641).

Conclusion: The results show that when asymptomatic HIV positive patients are treated operatively for acute long bone fractures, be they closed or compound, the rate of surgical wound infection is comparable to those of HIV negative patients.

Reports on bleeding tendencies in osteogenesis imperfecta (OI) are rare in the literature. Abnormalities are attributed to a defect in the vessel wall.

In a prospective study of 36 patients with known OI, we used the thrombo-elastogram (TEG) to survey haemostatic competence. TEG, which can indicate the nature of a haemostatic defect within an hour, provides a graphic representation of clotting. The study was conducted from July 2000 to April 2001. The ages of the 18 male and 18 female patients ranged from 9 months to 21 years (mean 10.7 years). Three had type-I OI, 27 type-III and six type-IV. Blood specimens were taken according to a TEG protocol and, to correlate with other bleeding tests, specimens were analysed for platelet count, prothrombin time (PT) and partial thromboplastin time (PTT).

Platelet counts were normal in all patients. PT and PTT were normal in all but one patient. When TEG results were compared with standard values, 30 patients had normal results, four had increased coagulation and two had a decreased coagulable state directly attributed to platelet defects.

Haemostatic defects in OI may be due to platelet function abnormalities. TEG, an inexpensive, simple, sensitive and reliable screening instrument, should be used before surgery to identify bleeding tendencies in OI patients.