Abstract
IntroductionPaediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. In sub-Saharan Africa, traditional healers are renowned for managing fractures and there is a neglect for specialized pediatric fracture care. We aimed to determine the demographic characteristics, clinical presentation, treatment patterns and outcomes of paediatric fractures in a tertiary health care centre in Yaoundé.MethodsWe conducted a prospective cohort study of all consenting consecutive cases of fractures in patients younger than 16 years managed between January 2011 and June 2015 at the University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcome of treatment at 12 months of follow-up.ResultsWe enrolled 147 fractures from 145 children with a mean age of 7 years and male-to-female sex ratio of 2.5:1. The main mechanisms of injury were games (53%) and accidental falls (20.7%). Forearm fractures were the most common fractures (38%). The mainstay of management was non-operative in 130 (88.5%) fractures, with 29.3% manipulations under anesthesia and 17 (11.5%) open reductions with internal fixation. The most surgically reduced fractures were supracondylar humeral fractures. Major difficulties were long therapeutic delay, lack of diligent anaesthesia and the lack of fluoroscopy. The outcome of treatment was favorable in 146 (99.3%) paediatric fractures.ConclusionWith the growing population of sub-Saharan Africa and the objective of becoming an emergent region, public policies should match the technical realities.
Highlights
Paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling
We systematically applied the guidelines of the paediatric orthopaedic and traumatology department of Brugmann hospital (Hopital Universitaire des Enfants Reine Fabiola) in Brussels where we underwent a fellowship, in a bid to identify the therapeutic challenges to standard and safe management of paediatric fractures in our resource-limited setting and thereby propose local solutions to amend these guidelines to our specific environment
The outcome was evaluated as poor if there was mal-union that could not be corrected by bone remodeling; acceptable when insufficient reduction was corrected by bone remodeling with no resultant functional impairment; and good when the reduction was anatomical.The following fracture types were considered as indications for open reduction and fixation; displaced supracondylar humeral fractures (Gartland Type III), lateral humeral condylar fractures, displaced forearm fractures or insufficient reduction, femoral fractures in skeletal matured children, opened Gustilo III fractures of any limb, multiple fractures and fractures associated with head injury
Summary
Paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. Fractures occur in about 25% of all injured children [1] The mechanisms of these injuries vary from accidental falls during recreational activities to road traffic accidents. Non-operative management is the mainstay of treatment of paediatric fractures, with reported good outcomes owing to the active remodelling potential of children's periosteum which speeds up the fracture healing process [2, 3]. Paediatric fractures are increasingly being managed by non-orthopedic surgeons, including traditional healers in sub-Saharan Africa. There exist some indications for surgical fixation of paediatric fractures, namely; open fractures, lateral condyle fractures of humerus, displaced supracondylar humeral fractures,femoralfractures in school aged children and the presence of associated injuries like head trauma or vascular lesion [1, 4].
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