Functional Outcome of Patients with Long Bone Fractures Discharged against Medical Advice before Definitive Treatment at the Yaounde Emergency Center: A Retrospective and Prospective Study

Background: Fractures of the long bones are becoming increasingly common in our environment, due to the upsurge in road accidents. In low- and middle-income countries such as Cameroon, where universal health coverage is still in its infancy, patients tend to orient their treatment choices according to their financial means. This study aimed to assess the functional outcome of patients with long bone fractures discharged against medical advice at the Yaounde Emergency Center. Methods: We conducted a retrospective and prospective descriptive and analytical study at the Yaounde Emergency Center (YEC). The study period was from June 2015 to December 2021. Any patient aged 18 or over with at least one long-bone fracture (humerus, radius, ulna, femur, tibia, fibula) discharged against medical advice from our study site and during the study period was included in the study. Sociodemographic and radio-clinical data were collected by examining the admission registers of the main care area, the trauma department, the hospitalization department, and the medical records. Patients were then contacted by telephone to invite them to return to the hospital to collect the type of treatment undertaken and we assessed the functional outcome. Statistical analyses were performed using SPSS version 26 software. Results: We found 206 patients in whom we were able to assess treatment and functional prognosis. The mean age was 35.4 (±13.8) years, and 165 (73.4%) were male. After discharge against medical advice, 124 (60.4%) patients opted for traditional fracture treatment, 76 (36.9%) preferred another hospital and 6 (2.7%) opted for therapeutic abstention. The average duration of traditional treatment was 91.70 (±53.73) days, with extremes ranging from 21 to 180 days. Massage was the main method of traditional treatment in 81 (65.59%) patients. The average hospital stay for medical treatment was 12.39 (±10.18) days, with extremes ranging from 2 to 45 days. Osteosynthesis was the medical treatment method used in 68 (87.8%) patients. The walking rate in patients opting for traditional treatment was 78.43%, with a normal walking rate of 56.86%. The walking rate in patients opting for medical treatment was 90%, with a normal walking rate of 85%. The rate of patients who regained normal walking was significantly higher in patients treated in other health facilities (85%) than in those treated by a traditional bonesetter (56.86%), (p= 0.046). Conclusion: In our environment, the majority of patients go to traditional bonesetters for the treatment of long-bone fractures, while others have left the Emergency Center in preference to another or to reunite with their families. Medical treatment has better results than traditional treatment, with the majority of patients regaining the functionality of their limbs and resuming their activities.