Distal Radius Fracture in the Setting of Human Immunodeficiency Virus: Management and Adverse Events

Abstract

Purpose: Previous research has highlighted the elevated fracture risk among patients with human immunodeficiency virus (HIV). The current study assesses the association between HIV and the management and adverse events of distal radius fractures. Methods: Patients with a distal radius fracture from 2016 to 2022 were identified in a national administrative database. Patients were stratified by HIV status, and antiretroviral therapy (ART) use was identified. Fracture treatment modality (open or closed) was determined, and adverse events were identified within 1 year of fracture. Treatment modality and adverse events were compared using logistic regression and chi-square tests, respectively. Results: Among 396,544 patients with a distal radius fracture, 2,392 had HIV. HIV status was not associated with treatment modality. For patients with closed treatment, those with HIV had greater rates of malunion or nonunion and wrist arthritis. For patients with open treatment, HIV was also associated with greater incidence of malunion or nonunion. When stratifying by ART status, patients not on ART were less likely to undergo open treatment, whereas those with ART underwent open treatment at similar rates to HIV-negative patients. Compared with the HIV-negative cohort, those with HIV, and on ART were significantly more likely to sustain malunion or nonunion following closed treatment. Conclusions: Patients with HIV are at increased risk for fracture, and they are more likely to experience adverse events following both closed and open management of distal radius fractures. Surgeons should pay close attention to bone healing in patients with HIV, and future research should investigate the causes of these adverse events and assess their modifiable risk factors. Type of study/level of evidence: Prognostic II.