Timing of orthopaedic surgical interventions and factors contributing to delays in femoral fracture management among adults in South Africa: insights from a prospective cohort study.

Abstract

To determine the time intervals between injury and orthopaedic admission, admission and surgery, and postsurgery length of stay and to elucidate factors contributing to delays in accessing orthopaedic services. Prospective cohort study. A tertiary hospital in the rural Eastern Cape province of South Africa. 413 adult patients admitted with femur fractures between January 2024 and July 2024. The primary outcome was the time interval from injury to surgical fixation. Secondary outcomes included time from admission to surgery, length of hospital stay and reasons for delays. Of 413 patients, only 22% (n=91) received surgical intervention within 48 hours of admission. The median time from injury to admission was 4 days (IQR 0-12), and injury to surgery was 13 days (IQR 0-713). Systemic factors, including limited theatre capacity and bed shortages, were the main reasons for delays. In the multivariate analysis, cardiac disease (adjusted OR, AOR=9.62), diabetes mellitus (AOR=4.36) and a Glasgow Coma Scale score of <8 (AOR=30.17) were significantly associated with higher mortality rates. Significant delays in femoral fracture fixation were observed, with fewer than 10% receiving surgery within 48 hours of injury. Addressing surgical capacity and referral pathways is essential to improving timely access to care.