A Comprehensive Review of Hip Fractures in Sub-Saharan Africa: Contextual Challenges, Outcomes, and Pathways to Improved Care.

Neck of femur fractures remain a major cause of orthopaedic morbidity and mortality globally, with an increasing burden in Sub-Saharan Africa (SSA) as populations age and trauma persists among younger groups. This review summarises the epidemiology, pathophysiology, management, and system-level challenges associated with hip fractures across SSA. Through a narrative synthesis of 37 regionally relevant studies published between January 1995 and May 2025, we explore how systemic resource limitations, delayed presentation, comorbidities, and workforce shortages shape clinical outcomes. Despite advances in surgical training and capacity-building, the region continues to face unique constraints, including limited access to operative fixation, delayed presentation, workforce shortages, and socioeconomic barriers to care. Emerging regional data highlight a dual burden: fragility fractures in the elderly alongside high-energy trauma in younger adults. Mortality rates remain substantially higher than that in high-income countries, reflecting both systemic and peri-operative challenges. Efforts to integrate hip-fracture care into essential surgical packages and strengthen rehabilitation services are ongoing but at a slow pace and in only a few sub-regions. Investment in prevention, early surgical intervention, and workforce development will be critical to improving outcomes.