Factors which delay surgery following femoral neck fracture in rural Australia.

Jasmin Roberts, Barbara Taylor, David Buckley, Paul Finucane, Wagga Wagga Base Hospital & Murrumbidgee Local Health District

Introduction

Early surgical intervention is known to optimise outcomes following a femoral neck fracture. However, early surgery is not always feasible, for example when people live remotely from trauma centres. We aimed to determine the frequency of delayed surgery for people with a femoral neck of femur in a rural area of New South Wales and the reasons for such delays.

Methods

All patients admitted to WWBH in 2017 following a fractured neck of femur were identified at presentation and followed prospectively. We focused on those patients who underwent surgery more than 48 hours following fracture.

Results

Of the 184 patients identified, 141 (77%) underwent surgical repair within 48 hours of fracture. For the remaining 43 (23%) the delay in surgery ranged from three days to over a month. The reasons for delay were often multi-factorial with delay in presentation and/or diagnosis occurring in 23 (53%), medical instability in 15 (35%), prior treatment with anticoagulant or anti-platelet drugs in 9 (21%) and delay in transfer from a peripheral health facility in 9 (21%). There was no apparent reason for surgical delay in just one patient. All but one patient with delayed surgery survived to discharge from the orthopaedic unit.

Conclusion

In rural Australia, delays in surgical repair of femoral neck fractures are relatively common and usually unavoidable.