An audit of treatment of proximal humerus fractures type 3 and 4 of Neer classification in a resource-poor setting in Sub-Saharan Africa

Abstract

Objectives: The objective of this study was to describe the challenges associated with imaging proximal humerus fractures in developing countries. Methods: This retrospective, descriptive, and analytical study was multicenter and was conducted in several health establishments in Abidjan, Côte d’Ivoire, between January 2016 and March 2021. Patients had to be at least 16 years old at the time of surgery. Two-part fractures were not included in the study. A sample of 103 patients with proximal humerus fractures was included: 82 (79.6%) females and 21 (20.4%) males with a mean age of 46 years (Ranging: 21–68), treated by several surgical teams. Proximal humerus fractures were classified according to Neer classification. All fractures were treated surgically. Results: After a minimum follow-up of 36 months, treated patients were assessed clinically according to the Constant score. All fractures had healed. The results of the clinical examination carried out during the functional evaluation of the treated shoulders according to the Constant score were as follows: 25 (24.3%) excellent outcomes, 39 (37.9%) very good outcomes, 17 (16.5%) good outcomes, 13 (12.6%) outcomes considered average, and 14 (13.6%) poor outcomes. A total of 59 (57.3%) cases of complications were identified in this study. Treatment-related complications, such as local infection and malunion, were the most predominant. Conclusion: The high rates of poor outcomes and complications found in this study reflect the real difficulties of managing comminuted proximal humeral fractures in developing countries.