Characteristics of motorcycle related femoral shaft fractures and direct cost at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Femoral shaft fractures have been attributed to high energy mechanism mainly resulting from road traffic accidents and have been associated with high morbidity and mortality. Recently in Kenya there has been an increase in the use of motorcycles as a means of transport and form of employment among the youths; however motorcycle accidents have been on the rise causing severe injuries and fatalities to the riders, passengers and pedestrians. Previously the use of non-operative treatment methods in the management of femoral shaft fractures was associated with adverse complications but currently the use of surgical implants has resulted in reduction of length of hospital stay, early mobilization, healing and return to premorbid state with minimal complications. Locally there is insufficient published data of femur shaft fractures resulting from motorcycle accident with the cost of patient care. Objective: To determine the characteristics of motorcycle related femoral shaft fractures and direct cost to patient care at MTRH. Methods: The descriptive prospective study design was used. Study population were patients who sustained femoral shaft fractures as a result of a motorcycle crash managed at MTRH between January 2016 to December 2016. One hundred and forty-two patients were consecutively sampled after meeting inclusion criteria. The data captured by structured questionnaire after consent included patients’ demographic characteristics, fracture pattern based on Arbeitsgemeinschaft fűr Osteosynthesefragen classification (simple, wedge, complex), associated injuries, duration of hospital stay and direct medical costs. Data was analyzed using Statistical Analysis System software version 9.1. Associations between categorical variables were assessed using Pearson’s chi square test. Results were presented using tables and figures. Results: A total 112 males and 30 females were recruited with a mean age of 32 years. Forty-two percent (42%) had primary school education as their highest level of education attained. Seventy-four percent (74%) engaged in informal employment. Passengers (48%) were most affected, riders made up to 40% whereas 12% were pedestrians. Fifty-six percent (56%) had fractures of the right femur with none of the patients having bilateral. Apart from the femur fractures, 15% of associated injuries were in the lower limbs. Fiftyeight percent (58%) of the injuries resulted from motorcycle versus motor vehicle collision, 16% motorcycle versus pedestrians and the rest were motorcycle versus motorcycle and lone accidents. Closed fractures (82.39%) were commonest injuries. Simple type A fracture pattern (74.63%) were majority. All patients underwent operative treatment with 92.96% using locked intramedullary nail, 7.04% used external fixator and 2.82% had an external fixator that was later changed to an intramedullary nail. Mean time to surgery was 9 days (1-31). The average length of hospital stay was 18 days (2 - 120). The average direct medical cost for care amounted to Ksh. 74,142/= Conclusion: Characteristics of femur shaft fractures as a result of motorcycle crash at MTRH were similar to other studies; however, the cost of care was higher. Recommendation: Emphasis on road safety to all road users, targeting shortening hospital stay through subsidizing implant fee and steady supply, prompt provision of operative treatment, health insurance sensitization to the public. Further study with long term followup to ascertain the total burden of the fracture.