Radiological and clinical details of major adult limb fractures in a teaching hospital, AAU, Ethiopia

Abstract

Background: This prospective study done at Addis Ababa University, Medical Faculty, Department of Radiology, Tikur Anbessa Hospital was aimed at determining the causes, magnitude, radiological and Clinical patterns of major limb fractures in adults in a half- year period from March to August 2007.In Addis Ababa University, fractures are managed both conservatively and operatively, but for lack of implants or expertise, patient which should have been treated surgically are managed conservatively and stay very long (average hospital stay of 11 days) in the Hospital. Such knowledge helps to plan on the management of the fractures and resource-recruitment. .

Methods: This was a half-year cross-sectional higher institution based study of 422 adult patients with major fracture/s on the limbs. The study included all the major limb trauma patients who attended the 'surgical' and orthopedic Emergency department of T.A.U.H and had fracture at the same time. Data collection related to radiological variables was done by the research team to help reduce inter observer measurement variability. “Difficult” patterns were discussed further.

Results: During the study period there were a total of 422 orthopedic adult patients who sustained a major fracture of their limbs. Mean age was 35 years with a male to female ratio was 3:1. Pathological fractures were encountered only in two (0.5%) patients. Nearly half (202, 48%) of the traumatic fractures were due to road traffic accidents. The highest frequency of fracture occurred on the femur (68, 15%), tibiofibular bones (63, 14%) and the humerus (61, 13.5%). A little less than half (44.1%) half of the femur fractures were in the proximal one-third and about half of the tibiofibular fractures were in the distal third. Transverse fracture pattern was seen in about half of the fractures. Compound fracture occurred in 90 (21.3%) of the cases. Thirty four (7.6) of the fractures involved the hand and only 13 (2.9%) involved the foot bones.

Conclusion: The very high proportion of closed long bone shaft fractures in a center with limited number of beds compels short Hospital stay using efficient operative fixations, including SIGN interlocking nails, plates and other implants.. Road traffic accidents (RTAs) were responsible for almost half of the fractures. Machine injuries and fall injuries were second and third respectively. As the proportions and patterns of the leading causes of adult traumatic fractures remained steadily high over the many years (other similar studies published by the author on this journal), due mutisectorial attention should be emphasized once again to dwindle their burden