Clinical outcomes of internal fixation orthopaedic surgery in humanitarian settings: a retrospective cohort study at the Médecins Sans Frontières (MSF) trauma centre in Aden, Yemen

Abstract

Purpose: The Aden Trauma Centre in Yemen, supported by Médecins Sans Frontières (MSF), introduced internal fixation (IF) procedures to address the high burden of fractures as a result of road traffic accidents and conflict-related injuries. This study aimed to describe the clinical characteristics of patients undergoing IF, evaluate their complication and healing outcomes, and explore factors influencing postoperative results. Methods: A retrospective cohort design was employed, including all patients who underwent internal fixation—using SIGN nails or plates/screws—between January and December 2022. Demographic information, fracture characteristics, surgical techniques, and postoperative outcomes were analyzed. Cox proportional hazards models were used to identify key predictors of complications and bone healing. Results: A total of 177 patients (208 fractures) were included. The overall complication rate was 14.4%. Open fractures and comorbidities were significant predictors of complications, while type of implant (SIGN nail vs. plate/screws) did not affect complication risk. Around three-quarters of fractures achieved radiographic healing at a median of five to six months. Infection and other complications emerged as major risk factors for delayed or impaired union. About a quarter of patients defaulted from care, potentially underestimating late complications and nonunion rates. Conclusion: Findings indicate that IF is feasible and effective in this high-need, low-resource context, demonstrating complication rates in line with global estimates. Open fractures, comorbidities, and limited follow-up infrastructure remain the main challenges to optimizing outcomes in such contexts.