Introduction: This study evaluates the epidemiological, clinical, and therapeutic aspects of PFEF at Gabriel Touré University Hospital in Bamako, Mali. Methodology: This was a retrospective and prospective study involving 104 patients treated between January 1, 2020, and April 1, 2024. Results: FEPFs accounted for 26% of femoral fractures, affecting mostly men (sex ratio: 1.26) with a mean age of (61 ± 18.7) years. Good pre-fracture autonomy (mean Parker score: 7.5) was present in 83% of patients. Fractures Trochanteric fractures were common (56%), with a slight predominance on the right side. Bilateral PFEFs accounted for 3%. Domestic accidents were the main cause (47.1%). Associated injuries included distal radius and shaft fractures femoral, with four cases of staged fractures. Surgical treatment was predominant (97%), with the majority using the DHS screw-plate (50.6%) and total hip replacement (24.3%). Complications included infections (1.9%), shortenings (1.9%), and disassembly of equipment (4.8%). We recorded 18 deaths (17.3%). The functional results, evaluated in 85 patients according to the Merle d’Aubigné and Postel rating at the last follow-up (20.8 months), were satisfactory (excellent and good) in 93% of cases. Conclusion: Rapid, multidisciplinary care is essential to reduce mortality and complications while improving functional outcomes.
References
[1]
Ehlinger, M., Adam, P. and Bonnomet, F. (2014) Fracture de l’extrémité supérieure du fémur de l’adulte. EMC-AppareilLocomoteur, 9, 1-18.
[2]
Simon, P., Gouin, F., Veillard, D., Laffargue, P., Ehlinger, M., Bel, J., et al. (2008) Les fractures du col du fémur après 50 ans. Revue de Chirurgie Orthopédique etRéparatrice de l’Appareil Moteur, 94, 108-132. https://doi.org/10.1016/j.rco.2008.06.006
[3]
Sambrook, P. and Cooper, C. (2006) Osteoporosis. The Lancet, 367, 2010-2018. https://doi.org/10.1016/s0140-6736(06)68891-0
[4]
Berglund-Rödén, M., Swierstra, B.A., Wingstrand, H. and Thorngren, K. (1994) Prospective Comparison of Hip Fracture Treatment: 856 Cases Followed for 4 Months in the Netherlands and Sweden. Acta Orthopaedica Scandinavica, 65, 287-294. https://doi.org/10.3109/17453679408995455
[5]
Bodard, S., Edgard-Rosa, G., Azu Elos, A., et al. (2022) Orthopédie, Traumatologie. 2nd Edition, Éditions Vernazobres-Grego.
[6]
Haute Autorité de Santé (2016) Chirurgie des fractures de l’extrémité proximale du fémur chez les patients âgés. Méthode recommandations pour la pratique Clinique, 11-12.
[7]
Morice, A., Reina, N., Gracia, G., Bonnevialle, P., Laffosse, J., Wytrykowski, K., et al. (2017) Fractures de l’extrémité proximale du fémur chez les patients centenaires. Étude rétrospective de 39 patients. Revue de Chirurgie Orthopédique et Traumatologique, 103, 8-12. https://doi.org/10.1016/j.rcot.2016.11.019
[8]
Barry, A., Bangoura, M., Diallo, I.G., et al. (2021) Les fractures de l’extrémité supérieure du fémur de l’adulte: Aspects épidémiologiques et thérapeutiques dans le service d’Orthopédie. Traumatologie de l’hôpital Matlaboul Fawzaini de Touba. Sénégal, 141-145.
[9]
Laurent Desire, N.E. (2019) Traitement chirurgical des fractures de l’extrémité proximale du fémur chez l’adulte au CHU Gabriel Toure à propos de 23 cas. Mémoire de Spécialisation Orthopédie-Traumatologie, USTT-B, FMOS.
[10]
Almigdad, A.K., Alazaydeh, S.A., Mustafa, M.S.B., Alshawish, M.I. and Alfukaha, H.A. (2022) A Review of Proximal Femur Fracture Patterns, Etiologies and Sociodemographic Features. International Journal of Orthopaedics Sciences, 8, 115-118. https://doi.org/10.22271/ortho.2022.v8.i3b.3189
[11]
Pech-Ciau, B., Lima-Martínez, E., Espinosa-Cruz, G., Pacho-Aguilar, C., Huchim Lara, O. and Alejos-Gómez, R. (2021) Fractura de cadera en el adulto mayor: Epidemiología y costos de la atención. Acta Ortopédica Mexicana, 35, 341-347. https://doi.org/10.35366/103314
[12]
Ha, Y., Park, Y., Nam, K.W. and Kim, S. (2015) Trend in Hip Fracture Incidence and Mortality in Korea: A Prospective Cohort Study from 2002 to 2011. Journal of Korean Medical Science, 30, Article No. 483. https://doi.org/10.3346/jkms.2015.30.4.483
[13]
Manga Ziga RCC (2018) Profil clinique, thérapeutique et évolutif des fractures de l’extrémité supérieure du Fémur de l’adulte A Yaoundé. Etude transversale descriptive, Université de Yaoundé I, faculté de médecine et des sciences biomédicales.
[14]
Dembele, S. (2008) Etude des fractures du col du fémur dans le service de chirurgie orthopédique et traumatologique du CHU Gabriel touré: À propos de 20 cas. Prospective, USTT-B, FMOS.
[15]
Lamia, B. (2011) Fractures de l’extrémité supérieure du fémur. Thèse de médecine N°25, Université Cadi Ayyad Faculté de médecine et de pharmacie Marrakech.
[16]
Kannus, P., Parkkari, J., Sievänen, H., Heinonen, A., Vuori, I. and Järvinen, M. (1996) Epidemiology of Hip Fractures. Bone, 18, S57-S63. https://doi.org/10.1016/8756-3282(95)00381-9
[17]
Marks, R., Allegrante, J.P., Ronald MacKenzie, C. and Lane, J.M. (2003) Hip Fractures among the Elderly: Causes, Consequences and Control. Ageing Research Reviews, 2, 57-93. https://doi.org/10.1016/s1568-1637(02)00045-4
[18]
Rabemazava, A., Razafimahatratra, R., Rakotomaharo, A. and Razafimahandry, H.J.C. (2009) Aspects de prise en charge des fractures du fémur proximal à Antananarivo. Revue de Chirurgie Orthopédique et de Traumatologie Malgache, 1, 1-10.
[19]
Parker, M.J. and Handoll, H.H. (2006) Replacement Arthroplasty versus Internal Fixation for Extracapsular Hip Fractures in Adults. Cochrane Library. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000086.pub2/full
[20]
Palm, H., Posner, E., Ahler-Toftehøj, H., Siesing, P., Gylvin, S., Aasvang, T., et al. (2013) High Reliability of an Algorithm for Choice of Implants in Hip Fracture Patients. International Orthopaedics, 37, 1121-1126. https://doi.org/10.1007/s00264-013-1831-7
[21]
Bhandari, M., Devereaux, P.J., Swiontkowski, M.F., Tornetta, P., Obremskey, W., Koval, K.J., et al. (2003) Internal Fixation Compared with Arthroplasty for Displaced Fractures of the Femoral Neck. The Journal of Bone and Joint Surgery-American Volume, 85, 1673-1681. https://doi.org/10.2106/00004623-200309000-00004
[22]
Hanssen, A.D. and Spangehl, M.J. (2004) Treatment of the Infected Hip Replacement. Clinical Orthopaedics and Related Research, 420, 63-71. https://doi.org/10.1097/00003086-200403000-00010