Current Management and Outcomes of Femoral Neck Fractures in Older Adults in Yaoundé, Cameroon: A Six-year Study of 74 Cases

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.