Management and Outcomes of an Open Distal Femur Fracture in an HIV-Positive Patient: A Case Report From Madina Hospital, Somalia

Bashir Dahir Ahmed,1 Mohamed Hassan Mohamud,2 Omar Sidow Zubair,3 Mohamed Abdi Warsame,4 Tigad Abdisad Ali5 1Department of Orthopedics, Madina Hospital, Mogadishu, Somalia; 2Faculty of Medicine and Surgery, Zamzam University, Mogadishu, Somalia; 3Department of Tropical Medicine and Infectious Diseases, School of Postgraduate Studies, Benadir University, Mogadishu, Somalia; 4Department of Orthopedics, Waberi Hospital, Mogadishu, Somalia; 5Department of Infection Prevention and Control, Mogadishu Somalia–Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Omar Sidow Zubair, Email zubairsom@bu.edu.soBackground: HIV infection has historically been associated with impaired fracture healing due to immune dysregulation, altered inflammatory responses, and reduced bone mineral density. However, emerging evidence suggests that patients with well-controlled HIV receiving antiretroviral therapy (ART) may achieve surgical outcomes comparable to HIV-negative individuals, even following complex orthopedic trauma. This case report aims to describe the management and outcome of an open distal femur fracture in an HIV-positive patient in a resource-limited setting.Case Presentation: We report the case of a 25-year-old male with previously undiagnosed HIV infection who sustained an open, displaced distal femur fracture secondary to a gunshot injury. HIV infection was confirmed using a WHO-recommended sequential rapid testing algorithm. The patient demonstrated moderate immune competence (CD4 count: 400 cells/mm3). Initial management included prompt surgical debridement, copious irrigation, intravenous antibiotics, and temporary immobilization. Definitive internal fixation using a distal femoral locking plate was performed ten days later, alongside initiation of ART (tenofovir, lamivudine, and dolutegravir). Postoperative recovery was uncomplicated. Radiographic follow-up at one and eight months demonstrated complete fracture union and stable fixation without evidence of infection or implant failure.Conclusion: This case supports growing evidence that HIV infection, when appropriately diagnosed and managed, should not be considered a contraindication to internal fixation of open femoral fractures. Timely surgical intervention, adherence to open fracture management principles, and early initiation of ART can result in favorable outcomes, even in resource-limited settings.Keywords: HIV, open femur fracture, fracture healing, antiretroviral therapy, Somalia