Outcomes of femoral shaft fractures in Sub-Saharan Africa: A systematic review.

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-06-01 Epub Date: 2025-03-07 DOI:10.1007/s00264-025-06407-5

Patrick Birkenhead, Paul Joseph Birkenhead, Clara Vella, Maritz Laubscher, Sithombo Maqungo, Simon Matthew Graham

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引用次数: 0

Abstract

Purpose: Femoral shaft fractures are significant injuries and if not managed appropriately can result in high complication rates and long-term disability. These complex injuries occur at a higher rate across low and middle income countries and sub-Saharan Africa is thought to have a higher incidence than other regions across the world. This study aims to summarise the most up to date evidence surrounding the treatment and associated outcomes of adult femoral shaft fractures in sub-Saharan Africa - giving a clear understanding of current practices and highlighting potential areas for further research.

Methods: PubMed, Google Scholar, Africa Journals Online, Cochrane, Clinicaltrial.gov were searched using Boolean search strategies. Data collected included demographics, fracture classification, interventions, union rates, time to union, patient-reported outcomes / functional outcome scores, and secondary outcomes (orthopaedic and medical complications, malunion / non-union, length of admission).

Results: Twenty-three studies reporting 2,180 patients were included-73% (1592/2180) of patients were male, with a mean age of 35 years. Overall, 59% of patients were treated with intramedullary nailing (IMN), 23% with skeletal traction, and 14% with open reduction internal fixation (ORIF). There was a heterogeneity in practice in different regions, with the highest reported rates of IMN in Tanzania (99%), and lowest in Malawi (29.4%). Union rates were highest in IMN (82.4-100%) versus traction (48 - 100%) and ORIF (83.3-87%). Intramedullary nailing demonstrated a super complication profile, with better functional outcomes, shorter hospital stays and time to mobilisation.

Conclusion: Intramedullary nailing demonstrated superior clinical and functional outcomes compared to other modalities for the treatment of femur shaft fractures across sub-Saharan Africa. However, there is significant sparsity of research and variable management approaches across the region. Focused research to determine the burden of injury, current healthcare resources and cost-effective and appropriate interventions to improve outcomes are now a public health priority.

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撒哈拉以南非洲地区股骨干骨折的预后：一项系统综述。

目的：股骨干骨折是一种严重的损伤，如果处理不当，可导致高并发症发生率和长期残疾。这些复杂伤害在低收入和中等收入国家的发生率较高，撒哈拉以南非洲的发病率被认为高于世界其他地区。本研究旨在总结撒哈拉以南非洲地区成人股骨干骨折的治疗和相关结果的最新证据，为当前的实践提供清晰的认识，并强调进一步研究的潜在领域。方法：采用布尔搜索策略检索PubMed、谷歌Scholar、Africa Journals Online、Cochrane、Clinicaltrial.gov。收集的数据包括人口统计学、骨折分类、干预措施、愈合率、愈合时间、患者报告的结局/功能结局评分和次要结局（骨科和内科并发症、不愈合/不愈合、住院时间）。结果：23项研究共纳入2180例患者，其中73%（1592/2180）患者为男性，平均年龄35岁。总体而言，59%的患者采用髓内钉（IMN）， 23%采用骨牵引，14%采用切开复位内固定（ORIF）。不同地区的实践存在异质性，坦桑尼亚报告的IMN率最高（99%），马拉维最低（29.4%）。IMN的愈合率最高（82.4-100%），而牵引（48 -100%）和ORIF（83.3-87%）的愈合率最高。髓内钉显示出超级并发症，具有更好的功能结果，更短的住院时间和活动时间。结论：在撒哈拉以南非洲地区，髓内钉治疗股骨骨干骨折的临床和功能效果优于其他治疗方法。然而，整个地区的研究和可变管理方法明显缺乏。目前，确定伤害负担、现有医疗资源和具有成本效益的适当干预措施以改善结果的重点研究是公共卫生的优先事项。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.