Management and Outcomes of an Open Distal Femur Fracture in an HIV-Positive Patient: A Case Report From Madina...

HIV infection has historically been associated with impaired fracture healing due to immune dysregulation, altered inflammatory responses, and reduced bone mineral density. However, emerging evidence suggests that patients with well-controlled HIV receiving antiretroviral therapy (ART) may achieve surgical outcomes comparable to HIV-negative individuals, even following complex orthopedic trauma. This case report aims to describe the management and outcome of an open distal femur fracture in an HIV-positive patient in a resource-limited setting.

We report the case of a 25-year-old male with previously undiagnosed HIV infection who sustained an open, displaced distal femur fracture secondary to a gunshot injury. HIV infection was confirmed using a WHO-recommended sequential rapid testing algorithm. The patient demonstrated moderate immune competence (CD4 count: 400 cells/mm³). Initial management included prompt surgical debridement, copious irrigation, intravenous antibiotics, and temporary immobilization. Definitive internal fixation using a distal femoral locking plate was performed ten days later, alongside initiation of ART (tenofovir, lamivudine, and dolutegravir). Postoperative recovery was uncomplicated. Radiographic follow-up at one and eight months demonstrated complete fracture union and stable fixation without evidence of infection or implant failure.

This case supports growing evidence that HIV infection, when appropriately diagnosed and managed, should not be considered a contraindication to internal fixation of open femoral fractures. Timely surgical intervention, adherence to open fracture management principles, and early initiation of ART can result in favorable outcomes, even in resource-limited settings.