Clinical significance of change in bone mineral density in HIV-infected patients with broken limbs

• Nikita G. Doronin
• Sergey N. Khoroshkov
• Semen L. Maksimov
• Elena A. Litvina
• Alexander E. Mitichkin

Abstract

The aim of the study was to determine the relationship between the index of bone mineral density and the results of surgical treatment of fractures of the long bones of the extremities in HIV-infected patients.

Material and methods. 90 HIV-infected patients with closed fractures of the long bones of the extremities were selected for analysis. Bone mineral density was studied in 41 patients using two-energy X-ray absorptiometry. The T-criterion of bone mineral density was determined in comparison with the value of a healthy person at the age of 30 years. During the rehabilitation period, patients were monitored from discharge to the moment of fracture consolidation. The structure of postoperative complications was analyzed in all 90 patients.

Results. Analysis of the results of densitometry in 41 HIV-infected trauma patients, depending on the stage of HIV infection and the use of antiretroviral drugs in the anamnesis, in comparison with the results of surgical treatment. HIV-infected patients at stage IV or more of the disease, as well as those receiving antiretroviral therapy, are significantly more at risk of low-energy injury than patients at stage III of the disease and who have not previously received antiretroviral drugs. For HIV-infected patients at stage IV or more of the disease, as well as those receiving antiretroviral therapy, the development of osteopenia and osteoporosis is characteristic. In HIV-infected patients with a decrease in bone mineral density, fixation migration, secondary displacement of fragments, delayed consolidation of fractures, and the formation of false joints were significantly more common after osteosynthesis.

Conclusion. The advanced stage of HIV infection is not a reason for conservative treatment of closed fractures of the long bones of the extremities. With a decrease in bone mineral density in HIV-infected patients, it is necessary to use low-traumatic methods of osteosynthesis and the use of fixators with angular stability. A multidisciplinary approach is recommended for the timely correction of antiretroviral therapy, the appointment of therapy for osteoporosis.

Keywords:bone fractures, HIV infection, bone mineral density, osteosynthesis, complications

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