Management of ballistic fractures of the femur at Centre Hospitalier Universitaire la Renaissance de N'Djamena (Chad): About 23 cases

Introduction: Ballistic trauma has become common in several countries in the subregion. The objective of this study was to present the results of the treatment of ballistic femur fractures in our center according to the department's protocol. Patients and methods: This was a cross-sectional study with retrospective data collection, conducted over a period of 4 years and 7 months from January 2020 to July 2024, involving 22 patients (23 cases) treated in the department for ballistic fractures of the femur according to the protocol of temporary bone stabilization, followed by secondary internal fixation. provisional bone stabilization, followed by secondary internal fixation. Results: We collected data on a total of 22 patients presenting with 23 cases of ballistic fractures of the femur. The average age was 31.5 years, with a clear male predominance and a sex ratio of 6.33 (19M/3F). The average time between trauma and admission was 11.6 hours. Military personnel were the most affected professionals, accounting for 72.8% of cases (n=16). In most cases, the weapon used was a military weapon, accounting for 9 cases or 40.9% of cases. The most common type of skin opening was type II in 47.8% of cases (n=11), followed by type III A in 34.8% of cases (n=8). Initial treatment consisted of primary debridement and stabilization by exofixation in 65.2% of cases (n=15), by crural-pedal cast in 21.7% of cases (n=5), and by trans-tibial traction in 13.1% of cases (n=3). Secondary internal osteosynthesis was performed within an average of 18.7 days (range: 12 days to 42 days). The outcome was favorable in 59.1% of cases (n=13) and unfavorable in 40.9% (n=9), with complications dominated by surgical site infections in 13.6% of cases (n=3). Conclusion: The treatment of ballistic fractures of the femur according to the principle of trimming, temporary bone stabilization, followed by secondary internal fixation in this context has yielded satisfactory results.