Prevalence and associated factors of femoral shaft fractures among patients admitted with extremity fractures: experience from the largest trauma center in Ethiopia.

backgroundFemoral shaft fractures (FSFs) are critical injuries that impose a substantial burden on patients and society, frequently resulting in catastrophic loss of employment and long-term disability in low- and middle-income countries (LMICs). While clinical management often focuses on reactionary surgical fixation, the high incidence of road traffic injuries and geriatric falls in Ethiopia necessitates a shift toward systemic preventative medicine. This study aimed to determine the prevalence and associated factors of FSFs among adult patients at Ethiopia's largest trauma center to provide a bimodal evidence base for public health advocacy and injury prevention strategies.

methodsA hospital-based cross-sectional study was conducted at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital between September 2023 and August 2024. The study included adult patients (≥ 18 years) admitted for the management of extremity fractures. A systematic random sampling technique was used to select 419 medical records, of which 388 were complete and included in the final analysis. Data were extracted using a structured checklist and analyzed using SPSS version 27. Logistic regression was employed to identify factors associated with femoral shaft fractures.

resultsAmong 388 patients admitted with extremity fractures, 192 (49.5%) sustained femoral fractures. Of these, 56 had femoral shaft fractures, resulting in a prevalence of 14.4% (95% CI: 10.9-17.9) among all extremity admissions and 29.1% (95% CI: 22.7-35.6) among femoral fractures. Proximal femur fractures were the most common femoral sub-type (54.7%). Road traffic accidents (42.0%) and falls (40.7%) were the leading mechanisms. Multivariable analysis revealed that older age was a significant protective factor against shaft fractures compared to younger adults (19-45 years): age 46-65 (AOR = 0.23; 95% CI: 0.08-0.65; p = 0.006) and age > 66 (AOR = 0.05; 95% CI: 0.01-0.22; p < 0.001). Ground-level falls were significantly less likely to result in shaft fractures compared to falls from height (AOR = 0.07; 95% CI: 0.02-0.30; p < 0.001).

conclusionsFemoral fractures constitute a major proportion of the traumatic workload in Ethiopia. Our findings suggest that clinical excellence in surgical fixation is insufficient to address this burden. We advocate for a firm transition toward preventative medicine led by trauma and orthopedic associations. This must include a bimodal strategy: aggressive public campaigns for seatbelt and helmet enforcement to protect the young workforce from high-energy trauma, and the implementation of osteoporosis screening and fall-prevention programs to mitigate fragility fractures in the aging population.