Osteonecrosis of the femoral head in people living with HIV: anatomopathological description and p24 antigen test.

OBJECTIVE: To examine the presence of HIV in bone tissue of people living with HIV (PLWHIV) with osteonecrosis of femoral head and describe clinical and anatomopathological findings. DESIGN: This is a case series which included 44 PLWHIV with osteonecrosis of femoral head who underwent total hip arthroplasty. METHODS: Clinical data were obtained through analysis of the patients' medical records. Bone tissue obtained during total hip arthroplasty was retrieved and sent for conventional and immunohistochemical analysis. Monoclonal antibodies were used to mark the p24 (HIV), CD31 (vascular endothelial cells), CD68 (macrophages), and D240 (cells of the lymphatic endothelium) antigens. RESULTS: Dyslipidemia was found in 48% of the patients and lipodystrophy in 31%. Histological analysis showed similar characteristics for the entire sample. Degeneration of joint cartilage was visualized with the presence of fissures and fibrillations, as well as subchondral sclerosis and necrosis of the subchondral cancellous bone tissue. Lymphoplasmocytic inflammatory reaction was observed, with the presence of macrophages containing a foamy, vacuolated cytoplasm, as well as the presence of ceroid pigment and occasional granulation tissue. The reaction with the monoclonal anti-p24 antibody was negative in the samples from all 44 PLWHIV undergoing hip arthroplasty. Reactions with the anti-CD31 and anti-D240 antibodies were negative. Staining with CD68 antibody confirmed that the cells visualized with foamy, vacuolated cytoplasm were macrophages. CONCLUSION: p24 HIV antigen was not detected in the bone tissue of PLWHIV and osteonecrosis. The most frequent anatomopathological findings were extensive necrosis of bone tissue, large vacuoles filled with fat cells, inflammatory lymphoplasmocytic reaction with macrophages containing vacuolated cytoplasm, and the presence of ceroid pigment.

Advances in treating exposed fractures.

The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.

O manejo das fraturas expostas é discutido desde a antiguidade e permanece de grande interesse da ortopedia e da traumatologia modernas. São lesões ainda desafiadoras. Infecção e não união são complicações temidas. Aspectos no diagnóstico, classificação e manejo inicial são discutidos. São essenciais a administração precoce de antibióticos, a limpeza cirúrgica e o debridamento meticuloso. Devem ser levadas em consideração as condições sistêmicas do paciente politraumatizado e as condições locais do membro acometido. A estabilização esquelética precoce é necessária. A fixação definitiva deve ser considerada quando possível e métodos de fixação provisória devem ser usados quando necessário. O fechamento precoce deve ser almejado e pode-se fazer uso de retalhos para esse fim.