Indications and Results of Surgical Treatment of Proximal Femoral Fractures in Adults at Ouagadougou

Abstract

Background: Functional treatment of proximal femur fractures (PFF) is being discontinued with advances in surgery and anesthesia. Suspension traction is used as a waiting treatment before surgery when technical, material and financial conditions are not met. The surgical treatment of these fractures must ensure a stable reduction and fixation, to allow early support to the patient who will quickly regain his previous autonomy. Objective: To specify the indications for surgical treatment of proximal fractures in adult in order to evaluate the results in the context of Burkina Faso. Patients and Methods: We conducted a retrospective study including adult patients hospitalized and followed up for proximal femoral fracture (PFF) in the orthopedic-traumatology department of the Yalgado Ouedraogo University Hospital Center at Ouagadougou. Among 310 patients presenting with PFF in 5.5 years, (56 cases a year (10.4%)), we focused on those whose PFFs were treated by surgical methods and followed up. Patients treated with orthopedic (40.1%) or functional (6.8%) methods, patients with incomplete records and those having signed a discharge against medical advice were excluded. A total of 94 patients, with 95 PFFs treated by surgical methods, constituted our study population. Road traffic accidents (51.1%) and domestic accidents (48.9%) were the predominant etiologies. The functional criteria of Postel Merle d’Aubigné (PMA) were used for the evaluation of the results (Table 1). Results: A total of 65 men and 29 women (sex ratio 2.2), aged of average 56 years, were recorded. Trochanteric mass fractures were predominant with 63 cases (66.3%), including one case of bilateral fracture and one case of an open fracture; we also reported 32 femoral neck fractures (33.7%). Osteosynthesis was performed in 66 patients (70.2%) and hip arthroplasty in the remaining 28 patients (29.8%). Osteosynthesis with DHS plate screws was performed in 49 cases (73.1%) and Moore type cephalic arthroplasty in 18 cases (64.3%). Two patients (2.1%) died, one in shock state and the second by pulmonary embolism. The main complications were 3 superficial infections (3.16%), 10 painful coxitis (35.7%) and one pseudarthrosis (dismantling of the material). Despite these complications, functional outcomes were satisfactory in 88.7%, poor in 9.7% and fair in 1.6%. Conclusion: Surgical treatment of proximal femoral fractures allows early removal and rapid functional rehabilitation; which improves functional outcomes and increases the quality of life in elderly patients.