Treatment and outcome of proximal femur fractures in a resource limited setting: a prospective observational study in rural Tanzania.

INTRODUCTION: Proximal femur fractures are a common type of fracture worldwide and are known to result in high disability and mortality rates. In resource-limited settings, these fractures are suspected to be an underreported problem. This study provides an overview of the different treatment modalities and outcomes of patients with a proximal femur fracture in rural Tanzania.

METHODS: A prospective observational study was conducted in a rural referral hospital in Tanzania. Between August 2019 and August 2020 patients admitted with a proximal femur fracture were included. Data on fracture type, treatment and outcome were collected up to one year after admission. Outcome included mortality, disability (Harris Hip Score (HHS), WHODAS 2.0) and Quality of Life (EQ-5D-3L, QoL).

RESULTS: Diagnosis: forty-seven patients were included, with a median age of 70 years (IQR 58-81). Thirty patients (30/47, 64%) sustained their injury due to a fall from standing height and eight patients were involved in a motor traffic accident. Eleven patients (11/47, 23%) sustained a femoral neck fracture, 24 patients (51%) sustained an intertrochanteric fracture and five patients (11%) sustained a subtrochanteric fracture. Five patients had additional injuries.

TREATMENT: eleven patients (11/47, 23%) received no treatment; 27 patients (57%) were treated conservatively; seven patients (15%) received an intramedullary nail. One Girdlestone (2%) was performed and one patient (2%) was referred to another hospital for operative treatment.

OUTCOME: The one-year follow-up rate was 96% (45/47). One-year mortality rate was 28% (13/47). Eleven patients (11/32, 34%) recovered to the disability level as reported prior to the injury (WHODAS 2.0). The HHS score showed a poor result in 21 patients (21/32, 66%; mean 62, SD 18). Seven patients had regained normal squat function. The QoL VAS at 3 months after admission was comparable to pre-injury reported general perceived health.

CONCLUSION: Most of the patients with proximal femur fractures are treated non-operatively and not according the current standard of care which is operative fixation or arthroplasty, resulting in limited functional outcome and high mortality rates. This data shows the importance of increased attention and the need for urgent improvement of fracture treatment and outcome in resource-limited settings.