Treatment incidence of orthopedic injuries among hiv-infected subjects in Taiwan: a dynamic cohort survey, 2005-2008

Background: The musculoskeletal system can be affected by a variety of abnormalities in association with HIV infection, and there is increasing concern regarding musculoskeletal trauma among the HIV-infected population. Methods: Based on Taiwan's nationwide insurance dataset (22,315 X 103 claimants in 2005, increasing to 22,918 X 103 in 2008), all subjects matching the inclusion criteria of HIV-infected codes in the annual ambulatory data files or the admissive data files during 2005-2008 were selected as the annual dynamic cohort population. The concomitant ICD9-CM diagnosis codes and associated treatment codes were evaluated and used as the inclusion criteria of orthopedic fractures or dislocations. The diagnosis codes of orthopedic injuries were classified into four major categories: upper extremities fracture, lower extremities fracture, trunk fracture and orthopedic dislocation. Results: In this dynamic cohort of HIV-infected Taiwanese, the treatment incidence of all orthopedic injuries (including fractures and dislocations) was 93.45 cases per 10,000 persons annually, with a 95% confidence interval (CI) of 84.15 to 102.77 per 10,000 during 2005-2008. The greatest annual incidence of various orthopedic injuries among HIV-infected Taiwanese was noted for radius/ulna or hand fracture (32.60/10,000), followed by femoral neck/femur fracture (18.60/10,000) and tibia/fibula or patella fracture (17.39/10,000); the incidence of upper/lower limb orthopedic dislocations was estimated to be 9.18 (95% CI 5.10-13.26) per 10,000. Males were at significant risk of clavicle/scapular fracture (RR: 4.15, 95%CI 2.15-6.15), femoral neck/femur fracture (RR: 2.43, 95%CI 1.42-3.44) and radius/ulna/hand fracture (RR: 2.35, 95%CI 1.58-3.12), and over 80% of these orthopedic fracture cases were treated using open methods. Conclusions:The HIV-infected population in Taiwan has a noteworthy risk of orthopedic injuries, and in most cases operative treatment is required.