Vol. 8, Issue 1, Part A (2026)

Background: Lower extremity fractures are a major cause of morbidity in Sub-Saharan Africa, often resulting from road traffic accidents and delayed surgical care. Evidence on long-term post-operative quality of life (QoL), functional recovery, and psychosocial outcomes is limited, hindering rehabilitation efforts and socioeconomic support.
Purpose: To evaluate post-operative QoL and functional outcomes following surgical management of lower extremity fractures in Sub-Saharan Africa.
Methods: A systematic review was conducted per PRISMA-2020 guidelines. PubMed, Embase, Cochrane, Web of Science, African Index of Medicine, African Journal of Medicine, and Global Health Journal were searched for English- and French-language studies (2000-2025) reporting QoL after surgical management of lower extremity fractures in Sub-Saharan Africa. Screening was done via Rayyan, with data extracted on health-related QoL (HRQoL), functional recovery, psychosocial outcomes, and complications. Risk of bias was assessed using MINORS criteria.
Results: Thirty-seven studies (n = 3,780 patients; 3,784 fractures) met inclusion criteria. Road traffic accidents were the most common cause (n = 2,199), and femoral (n = 1,875) and tibial (n = 1,793) fractures predominated. Intramedullary nailing was the most frequent intervention, associated with faster functional recovery, earlier union, and improved short-term HRQoL compared to external fixation or conservative management. Seventeen studies reported HRQoL outcomes, 27 assessed functional recovery, and 8 evaluated psychosocial outcomes. Postoperative infection and nonunion were reported in 7 and 10 studies, respectively. While short-term outcomes were generally favorable, long-term results showed persistent pain, functional limitations, diminished QoL, high infection risk in severe open fractures, and psychosocial burdens including financial strain and caregiver impact.
Conclusion: Surgical management yields high union rates and favorable early functional outcomes, especially with intramedullary nailing. However, long-term QoL is constrained by infections, persistent pain, and socioeconomic challenges. Expanding timely surgical access, modern fixation techniques, infection prevention, rehabilitation, and psychosocial support is critical to optimize sustained outcomes in Sub-Saharan Africa.
Study Design: Level IV, systematic review of II-IV studies