Osteosynthesis of Fractures in the Trochanteric Region in a Resource-Limited Context: Surgical Procedure and Outcomes at the National Hospital of Niamey, Republic of Niger

Abstract

Background: To describe the technique and outcomes of osteosynthesis for fractures of the trochanteric region using a dynamic hip screw (DHS) without a fluoroscopic image intensifier and orthopedic table in our department.Patients and Methods: This was a cross-sectional prospective study conducted in the Traumatology-Orthopedics and Reconstructive Surgery Department of the National Hospital of Niamey, Niger, over a 33-month period from December 10, 2020, to September 10, 2023. The study focused on the osteosynthesis technique for fractures of the trochanteric region using a dynamic hip screw (DHS) without a fluoroscopic image intensifier and without an orthopedic table, as well as preliminary outcomes in patients over 15 years old. The parameters studied included epidemiological, clinical, paraclinical (additional examinations), therapeutic, and evolutionary aspects.Results: Over 33 months, we recorded 130 cases of trochanteric fractures out of 4,025 fracture admissions, representing 3.23%. There were 90 women (69.20%) and 40 men (30.80%), with a female-to-male sex ratio of 2.25. The mean age was 60.62 years, ranging from 20 to 79 years. Clinically, all patients presented with pain, hip swelling, rotation, and limb shortening. Falls from standing height accounted for 53.8% (n= 70) of the trauma circumstances. Comorbidities such as hypertension, diabetes, sickle cell disease, and hepatitis B were found in 71.42% (n= 93) of patients. Radiologically, trochanteric-diaphyseal fractures were observed in 53.80% (n= 70). Surgical treatment was performed in all patients. The therapeutic outcomes were favorable in the majority of cases.Conclusions: Trochanteric fractures are common at the National Hospital of Niamey and primarily affect elderly women who have suffered falls. Treatment was exclusively surgical, using dynamic hip screws (DHS) without a fluoroscopic image intensifier or an orthopedic table. Most treatment outcomes were favorable.