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

Fonkoué Loic; Nyankoué Mebouinz Ferdinand; Ndzernyuy Dubila Fabrice; Nyekel Justine Raphaela; Muluem Oliver Kennedy; Handy Eoné Daniel

doi:10.18203/issn.2455-4510.IntJResOrthop20261732

Authors

Fonkoué Loic Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Department of Surgery, General Hospital, Yaoundé, Cameroon
Nyankoué Mebouinz Ferdinand Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Department of Surgery, University Teaching Hospital of Yaounde, Cameroon
Ndzernyuy Dubila Fabrice Department of Surgery, General Hospital, Yaoundé, Cameroon
Nyekel Justine Raphaela Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon
Muluem Oliver Kennedy Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Department of Surgery, General Hospital, Yaoundé, Cameroon
Handy Eoné Daniel Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Department of Surgery, General Hospital, Yaoundé, Cameroon

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261732

Keywords:

Fracture, Proximal humerus, Surgical treatment, Function, Resource-limited setting

Abstract

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.

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