DELAY TO SURGERY IN DISPLACED INTRACAPSULAR FEMORAL NECK FRACTURES IN ADULTS AGED LESS THAN 65 YEARS

Abstract

Introduction: Intracapsular femoral neck fractures in adults under 65 years old are associated with significant complications such as avascular necrosis of the femoral head and non-union. Timing of surgery remains controversial, with some studies suggesting that early surgical fixation reduces the rate of these complications. Presently the policy in this Fracture Unit remains early fixation (target less than twelve hours). The purpose of this study is to determine if this twelve hour target is being achieved and if not, where the delays are occurring.

Methods: A retrospective case-note and data analysis was performed on all patients aged under 65 who underwent internal fixation of displaced intracapsular femoral neck fractures (Garden III/IV) between 31/12/06 and 31/12/07. The following data was collected; time of injury to presentation at health service, time from presentation at health service to admission at treating hospital, time of admission at treating hospital to time of surgery and overall time from injury to surgery. The main causes of delay were also determined.

Results: In the one year period, there were 37 young adults with displaced intracapsular femoral neck fractures, with a mean age of 52.57 years. There were 23 females (62.2%) and 14 males (37.8%).

We also present the reasons for delay at each stage including transfer delays, medical delays and limited emergency theatre availability.

Discussion: Early operative fixation of young femoral neck fractures remains controversial. In this unit where it is advocated, the median time from injury to fixation is 22.18 hours. By reducing transfer times, increasing emergency theatre availability and improving efficiency of patient preparation for theatre at ward level, the twelve hour targets will be much more attainable.