Prevalence, Aetiology, and Outcomes of Pathological Fractures in the Douala General Hospital: A 5-Year Retrospective Study

Introduction: Pathological fractures (PF) have a global prevalence of about 28%. Treatment requires a well-defined standardised plan, and a holistic approach of the cases while considering their somewhat poor prognosis especially in settings with limited diagnostic and therapeutic facilities. Our aim is therefore to describe the characteristics of pathological fractures diagnosed and treated in the Douala General Hospital, a level referral Hospital in Cameroon. Methods: This is a 5-year retrospective study carried out from 1^st January 2018 to 31^st December 2022. Files of patients with pathological fractures were included. Clinical data including the age, the occupation, and etiology of the pathological fractures, type of fracture, the treatment and the outcomes were recorded. Analysis was done using the Statistical Package for Social Sciences (SPSS) version 25 (P-value < 0.005; CI = 95%). Results: A total of 1320 cases of fractures were treated during the study period, amongst which 66 were pathological fractures, representing a prevalence of 5% in the DGH. However, 2 files of PF were excluded due to incomplete information. Hence, 64 files were considered for analysis; The mean age was 62.59 ± 16.34 years. Most cases were due to osteoporosis (51.6%), breast cancer metastasis (25%) and multiple myeloma (15.6%). Surgery was the most common treatment modality used (48.4%), including internal fixation, arthroplasty and external fixation. There was a significant association between the aetiologies of PF and management options. 84.4% of cases were discharged while 15.6% passed away. After discharge, 7.8% cases were reported dead, 45.3% of cases were loss of follow-up, 23.4% recovered with disability and 7.8% completely recovered. Conclusion: The occurrence of PF in the DGH is relatively low, with a higher incidence among females. Osteoporosis was the most common underlying aetiology. Available treatments, which include surgery, immobilization technics and adjuvant therapy unfortunately tend to result in poor outcomes and it was more pronounced on osteoporotic PF.