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.

OBJECTIVES: 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. DESIGN: Prospective cohort study. SETTING: A tertiary hospital in the rural Eastern Cape province of South Africa. PARTICIPANTS: 413 adult patients admitted with femur fractures between January 2024 and July 2024. PRIMARY AND SECONDARY OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.