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Background: Fractures are more and more frequent, because of the extent of traffic road accidents and the rise of moto-taxis in Cameroon context. However, there are major public health challenges in the therapeutic response within the pyramidal care chain. Method: This was a cross-sectional study with mixed component (qualitative and quantitative) that lasted ten months (from October 2017 to July 2018). It covered a six-year period (between 2012 and 2018) and was carried in the departments of orthopedic surgery and traumatology of Yaoundé Central Hospital. Included were the medical records of patients with fractures. Results: The sample consisted of 428 patients, with a clear male predominance (sex ratio of 2.6) and a median age of 39 years. Biomedicine and ethnomedicine represented the most widely used treatment options in first (52.3%) and second-line (57%) respectively. As for self-medication, it constituted 44% of the first recourse, because of its geographical accessibility, and 40.2% of the third remedies. The orthopedic itineraries are very erratic, because of the medical pluralism observed within the health system. In addition, the therapeutic response within the pyramidal care chain has been marked by several public health challenges. They were respectively epidemiological (with extent of fractures and traffic road accidents), organizational (due to poor organization of front-line services) and financial (because of ineffectiveness of universal health coverage and socio-economic context specific to low-resource countries). Conclusion: This study will make efficient data available to stakeholders, in order to improve the supply’s organization of orthopedic care according to the demand, through perspectives of resolution of epidemiological, organizational and financial challenges in the pyramidal chain of fractures management.

Orthopedic itineraries and public health challenges in the management of fractures in a tertiary hospital in Yaoundé Cameroon