Femoral Shaft Fracture Epidemiology in Adults and Outcomes at Four Hospitals in the Western Cameroon

Abstract

Introduction: Femoral shaft fractures (FSFs) in adults are a major trauma emergency, with high functional morbidity when treatment is delayed or inappropriate. In middle income countries with low resource hospital settings like in the Western Cameroon, optimizing treatment remains an organizational and technical challenge. Materials and Methods: This was a multicentre hospital based study done for four year in West Cameron with cross-sectional, descriptive, and analytical study design combining retrospective (January 1, 2020, to December 31, 2024) and prospective (January 1 to April 30, 2025) data collection, conducted in four referral hospitals in the West Region. Patients admitted for femoral shaft fractures were studied in terms of their clinical profile, treatment, and evolution. To analyze prognostic factors, a case-control study (“complicated cases” versus “uncomplicated cases”) was conducted in strict compliance with ethical procedures. Statistical analysis was performed using SPSS. Results: Five hundred and twenty (520) femoral shaft fractures were studied, including 6 bilateral fractures (1.15%) and have brought new local data. The average age was 39 ± 17 years and the sex ratio was 2.33 in favor of men. The cause was a road traffic accident in 428 cases (82.31%), of which 332 (80.58%) involved a motorcycle. Closed fractures accounted for 388 (74.6%) cases; the AO 32-A type predominated with 268 (51.5%) cases. The median time to surgery was 7 days. There were 376 (72.31%) intramedullary nails, of which 369 (70.96%) were locked and 120 (23.07%) were screw plates/plate blades, 70 (13.46%) pins, 24 (4.62%) external fixators, and 24 (4.62%) steel wires. Union was achieved in 408 (78.46%) cases, with a mean time to full weight-bearing without a crutch of 6.2+3.4 months. Postoperative complications occurred in 128 (24.62%) cases, including 29 (5.58%) cases of pseudarthrosis. Factors independently associated with complications were: poor reduction (aOR 13.08; 95% CI 4.31–39.66), major medical comorbidity (aOR 4.04; 1.30–12.50) and a delay > 24 hours between trauma and admission (aOR 4.03; 1.58–10.30). Conclusion: This study of 520 fractures in Western Cameroon, revealed that stable closed nailing of a simple mid-third diaphyseal fracture, performed promptly after proper reduction in a young, non-diabetic, non-smoking patient, offers the best outcome. Factors associated to poor outcome should be considered by those working in areas similar to ours.