Femur fractures; its associated factors, and treatment outcomes at Gulu Regional Referral Hospital in Uganda. A retrospective review of Hospital records in 2022.
Authors: Okwada Isaac , Longoli Isaac , Ukwang Santo , Tumuhaise Ludovico , Okema Louis , Kitara David Lagoro 
Published: November 2023

Abstract
Background.
Globally, physical injuries are the leading causes of disability-adjusted life years (DALYs), morbidity, and mortality, and account for nearly four and a half million lives lost per year, or approximately 8% of the world's annual deaths. In Uganda, physical injuries are a substantial problem that has reached epidemic proportions, with Boda-boda accidents being the leading cause of injuries. This study aimed to determine the factors associated with femur fracture and treatment outcomes at Gulu Regional Referral Hospital in 2022.
Materials and Methods.
An IRB-approved retrospective review of patients 18 years and above who sustained femur fractures and were treated at Gulu Regional Referral Hospital's Department of Surgery in 2022 was conducted. A systematic sampling of patients' files from the records in the surgery department was conducted. Two groups of patients were classified based on whether they received an operative or nonoperative femur fracture reduction at Gulu Hospital. The study's primary outcome was the factors associated with femur fracture and the discharge status of the patients after treatment. Multivariate regression analyses were conducted to determine factors associated with femur fracture and status at discharge. A p-value of < 0.05 was considered significant at 95% Confidence Intervals (CI).
Results.
One hundred and fifty-four femur fracture patients were treated at GRRH with most, 91(58.8%) being males; in the age group of 18–30 years 38(24.8%); caused by road traffic crashes, 96(63.0%) and passengers, 60(60.6%); with mainly the shaft of femur affected 55(35.2%); of transverse fracture lines, 56/154(36.4%) and were closed fractures, 13(88.4%). At multivariate regression analyses, the factors associated with femur fracture were the age groups of 61–75 years (adjusted Odds Ratio = aOR,13.9, 95%CI:1.68-114.09;p = 0.015); age group > 75 years (aOR, 2.50,95%CI:1.22–4.95;p = 0.012); and diploma/degree holders (aOR,5.01,95%CI:1.03–15.68;p = 0.046). The factors associated with improved status at discharge after treatment at GRRH were occupations (aOR,4.02,95%CI:1.52–10.63;p = 0.005); open fractures (aOR, 0.13,95%CI:0.05–0.360;p < 0.000); oblique fracture lines (aOR,4.95,95%CI:1.62–15.12;p < 0.000); spiral fracture lines (aOR, 5.50, 95%CI:1.71–17.90;p = 0.004); transverse fracture lines (aOR,4.34,95%CI:1.68–11.23;p = 0.002). However, there was no significant difference in the method and treatment outcomes of femur fracture at GRRH in 2022.
Conclusion.
Femur fracture is a significant surgical and public health problem among Gulu Regional Referral Hospital patients. It is associated with older age groups and diploma/degree holders. The factors associated with improved status at discharge were occupations (peasant farmers and persons employed in the informal sectors of the economy), spiral, transverse, and oblique fracture lines. It was less likely for patients with open femur fractures to be discharged in an improved status. In addition, there was no significant difference in the treatment method and outcomes among the patients at GRRH. We recommend more strategies to reduce the incidence and prevalence of femur fractures by designing and reinforcing policies that reduce motor vehicle accidents in the region. In addition, more efforts should be made to supply enough implants for the management of patients with fractures using open reduction and internal fixation.