Current Management and Outcomes of Femoral Neck Fractures in Older Adults in Yaoundé, Cameroon: A Six-year Study of 74 Cases
Atemkeng Tsatedem Faustin *
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Wansi Chiago Yann Buitoni
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Djam Chefor Alain
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Guifo Marc Leroy
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Ngo Yamben Marie Ange
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Banga Nkomo David Douglas
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Amougou Boris
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Ngono Ateba Gladys
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Dongmo Arlette
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Njifou Njimah Amadou
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
Handy Eone Daniel
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Bahebeck Jean
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Ibrahima Farikou
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
*Author to whom correspondence should be addressed.
Abstract
Background: Femoral neck fractures are common among older adults and are associated with high morbidity and mortality. The main challenges are reducing mortality and improving functional outcomes.
Aim: This study aimed to describe the clinical characteristics, management, and outcomes of femoral neck fractures in Yaoundé.
Materials and Methods: We conducted a retrospective descriptive study over 6 years and 5 months, from 1 January 2018 to 31 May 2024. The target population comprised patients with femoral neck fractures followed at six major hospitals in the capital city of Yaoundé.
Results: Of 5,950 patients hospitalised in orthopaedic units across the six hospitals, 129 patients (prevalence 2.18%) had 130 femoral neck fractures, including one bilateral fracture. We included 74 patients, with a mean age of 64.34 ± 18.2 years. Men predominated, with a sex ratio of 1.24. Low-energy falls in older adults were the mechanism in 75.5% of cases. Comorbidities included hypertension (25.7%), HIV (12.1%), and diabetes mellitus (9.5%). Forty-two fractures occurred on the right and 32 on the left. Garden types I, II, III, and IV accounted for 1.35%, 8.11%, 43.24%, and 47.30% of fractures, respectively. The median delay from fracture to hospital arrival was 1 day, and the median delay to surgery was 16.5 days. Management comprised total hip arthroplasty (6.67%), hemiarthroplasty (48%), open reduction and internal fixation osteosynthesis (20%), and non-operative management (25%). The median postoperative stay from surgery to discharge was 11 days. Major complications included anaemia (65.2%), dislocation (15.6%), surgical site infection (11.7%), and fixation failure (3.8%). Blood transfusion was administered to 54 patients (72.97% of the 74-patient cohort). Nine patients (17.6%) underwent reoperation. The 1-year mortality rate was 17.6%. Good-to-excellent hip scores were recorded in 51% of patients. The median follow-up was 280 days (range, 1 month to 5 years and 8 months).
Conclusion: Femoral neck fractures were associated with substantial delays to surgery. Approximately one-fifth of patients died within the first year, and functional outcomes require improvement.
Keywords: Femoral neck fracture, older adults, hip fracture, hemiarthroplasty, internal fixation, surgical delay, postoperative complications