INFECTION FOLLOWING TREATMENT OF MANDIBULAR FRACTURES IN HUMAN-IMMUNODEFICIENCY-VIRUS SEROPOSITIVE PATIENTS

Purpose: There are little data available on the prevalence of human im munodeficiency virus (HIV) disease and its relationship to postoperati ve infection in patients presenting with mandibular fractures, This re trospective study assesses these parameters, Patients: The study popul ation consisted of 251 patients treated for mandibular fractures at Sa n Francisco General Hospital (SFGH) between January 1990 and December 1993, Group I (n = 20) was composed of patients with documented HIV in fection and group 2 (n = 231) served as controls. The groups were comp arable with regard to age, sex, etiology, and number and types of frac tures. Results, HIV prevalence for this population was 7.9%, and was c onsistent with previously documented prevalence studies in SFGH surgic al patients. In the HIV-positive group, 6 of 20 patients (30%) develop ed postoperative infection: 2 soft tissue (10%) and 4 bone-related (20 %). In the control group, 22 of 231 patients (9.5%) developed postoper ative infections: 16 soft tissue (6.9%) and 6 bone-related (2.6%), Sta tistical analysis showed a significant difference between the two grou ps with regard to overall (P = .016) and to bone-related (P = .001) in fection rates. There was no statistically significant difference in so ft tissue infections between the two groups (P = .953). The rate of po stoperative infection was significantly higher in those patients (both HIV-positive and controls) who had open reduction and internal fixati on (ORIF; 25/155; 16%) versus those who had closed reduction and maxil lomandibular fixation (3/96; 3.1%; P = .003), The postoperative infect ion rate after ORIF was significantly higher in the HIV-positive (5/11 , 45%) compared with the control group (20/144; 13.9%; P = .02). Concl usions: The results of this study indicate that the overall rate of po stoperative infection after treatment of mandibular fractures is signi ficantly higher in HIV-positive than in HIV-negative patients. Specifi cally, the use of ORIF in HIV-positive patients represents a significa nt risk.