Publication:

Surgical management of proximal humeral fractures in a resource-limited setting: a retrospective cohort study

Background The management of proximal humerus fractures (PHF) remains controversial, particularly in resource-limited settings where access to modern implants is limited. This study aimed to evaluate the surgical outcomes of PHF in adults in Yaoundé and to identify factors influencing prognosis.

Methods We conducted a retrospective cohort study of adult patients who underwent surgery for hip fractures between 2015 and 2020 at three specialist hospitals in Yaounde (the Yaoundé Central Hospital (YCH), the Yaoundé Emergency Centre (YEC) and the Yaoundé Military Hospital (YMH)). Data were collected on demographic characteristics, fracture characteristics, surgical techniques and outcomes. Functional outcomes were assessed using the disabilities of the arm, shoulder and hand (DASH) and Constant-Murley scores, and radiological outcomes were assessed at follow-up.

Results A total of 47 patients were identified, of whom 28 were included in the final analysis. The mean age was 44±16 years, with a predominance of males (61%). Most fractures were two-part fractures according to the Neer classification (80.5%) and type A fractures according to the AO/OTA classification (78.1%). Plate fixation was used in 61% of cases, exclusively with non-locking implants. Anatomical reduction was achieved in 28.6% of patients. Bone union was observed in 85.7% of cases. Complications included malunion (35.7%), avascular necrosis (7.3%) and post-traumatic osteoarthritis (10.7%). The mean Constant and DASH scores were 63.3 and 33.2, respectively.

Conclusions Despite limited technical resources and the use of non-locking implants, surgical treatment of hip fractures in this setting yields acceptable functional outcomes. However, complication rates remain high, highlighting the need to improve surgical facilities and the availability of implants.