Abstract
Background:Knowledge of the therapeutic patterns, challenges and outcomes of treatment of paediatric femoral fractures (PFF) helps to better choose the ideal therapeutic modality which is still controversial. However, this data is scarce in the sub-Saharan African literature.Objective:To determine the therapeutic patterns, treatment challenges and outcomes of treatment of PFF in a tertiary care centre in Cameroon.Method:We conducted a prospective cohort study of all consenting consecutive cases of femoral fractures in patients younger than 16 years managed between 2011 and 2015 at the surgical unit of Yaoundé University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcomes of treatment at 12 months using Flynn’s criteria.Results:We enrolled 30 femoral fractures from 29 children with mean age was 4.2 ± 3.3 years. The male gender, diaphyseal locations and spiral fracture lines were predominant. Main mechanisms of injury were accidental falls, road traffic accidents and game injuries. Fracture management entailed 12 tractions followed by casting, 10 casting alone, four closed reductions followed by casting, two cannulated screw fixations, one pin fixation and one external fixation. The mean duration of consolidation was 10.3 ± 3.9 weeks. The outcome was rated excellent in 28 cases. Limited resources precluded fluoroscopy use, proper anaesthetic management, early rehabilitation and patient-parent satisfaction.Conclusion:Conservative management of PFF yields a good outcome in our setting. However, an improvement in surgical, radiology and anaesthetic infrastructure is needed for optimal PFF care.
Highlights
Femoral fractures occur at a rate of 20 per 100,000 children in the USA, representing 1.6% of all paediatrics fractures [1], yet they inflict significant adverse physical, social, psychological, and financial impacts to both affected children and parents [2]
Conservative management of paediatric femoral fractures (PFF) yields a good outcome in our setting
We managed 30 femoral fractures from 29 children representing 20% of all paediatric fractures managed in our hospital
Summary
Femoral fractures occur at a rate of 20 per 100,000 children in the USA, representing 1.6% of all paediatrics fractures [1], yet they inflict significant adverse physical, social, psychological, and financial impacts to both affected children and parents [2]. The use of flexible intramedullary nailing has revolutionized the treatment of paediatric femoral fractures by improving on cost-effective results; early union due to repeated micro-motion at fracture site, respect for the physeal plates, early ambulation, minimal scaring, easy implant removal and tremendous patient satisfaction [8, 11]. This surgical option coupled with other invaluable health care infrastructures like fluoroscopy are still inexistent in many low-income countries, hindering efforts for current goal standard surgical reduction of paediatric femoral fractures [11]. This data is scarce in the sub-Saharan African literature
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