Naik Ketan Mahesh, Dakhode Shubham Y, Mhaisane Sahil, Nischay K K
Department of Orthopaedics, TNMC and BYL NAIR Charitable Hospital, Mumbai, Maharashtra, India.
Department of Orthopaedics, BJ Medical College and Sasson General Hospital, Pune, Maharashtra, India.
J Orthop Case Rep. 2023 Apr;13(4):16-20. doi: 10.13107/jocr.2023.v13.i04.3598.
It has been noticed that human immunodeficiency virus (HIV) infection and anti-retro viral (ART) therapy, both individually lead to bone metabolic disorders, and hence, such patients have an increased propensity for fractures following trivial trauma.
We present two cases, first a 52-year-old female with the right hip pain and inability to walk since 1 week following trivial trauma and associated dull pain in the left hip since 2 months ago. Radiographs revealed a right intertrochanteric fracture and a left unicortical fracture at level of lesser-trochanter. The patient was managed with closed proximal femoral nailing bilaterally and subsequently mobilized. Second, a 70- year-old female with bilateral leg pain and swelling following trivial trauma since 3 days. Radiographs revealed a distal one-third shaft tibia and fibula fracture bilaterally managed with closed nailing bilaterally and subsequently mobilized. Both patients had HIV infection since 10 and 14 years, respectively, and were on combination ART.
There should be a high index of suspicion to the possibility of fragility fractures in HIV affected patients on ART. Principles of fracture fixation and early mobilization should be followed.
人们已经注意到，人类免疫缺陷病毒（HIV）感染和抗逆转录病毒（ART）治疗各自都会导致骨代谢紊乱，因此，这类患者在遭受轻微创伤后骨折的倾向增加。
我们呈现两例病例，第一例是一名52岁女性，自轻微创伤后1周起出现右髋部疼痛且无法行走，自2个月前起左髋部伴有隐痛。X线片显示右转子间骨折以及左小转子水平的单皮质骨折。该患者接受了双侧股骨近端闭合髓内钉固定术，随后进行了活动。第二例是一名70岁女性，自轻微创伤后3天起出现双侧腿痛和肿胀。X线片显示双侧胫骨干骺端三分之一处及腓骨骨折，接受了双侧闭合髓内钉固定术，随后进行了活动。两名患者分别感染HIV 10年和14年，均接受联合抗逆转录病毒治疗。
对于接受抗逆转录病毒治疗的HIV感染患者，应高度怀疑其发生脆性骨折的可能性。应遵循骨折固定和早期活动的原则。
