Abstract
Introduction
Intracapsular fractures of the femoral neck in young adults are a surgical emergency. Recent literature reviews have questioned whether the timing of surgery reduces the incidence of avascular necrosis, non-union and revision.
A study was performed to determine how many patients met a 12-hour target for operative fixation with this injury. Possible sources of delay to theatre were reviewed.
Methods
A Fractures Outcomes Research Database was used to identify patients aged 18–64 who were admitted to the Royal Victoria Hospital in Belfast between 1st Jan 2008 and 31st Dec 2009. Intracapsular fractures of the femoral neck which were treated with a 2-hole dynamic hip screw were included. Time of injury, time of presentation in A&E, time of admission to fracture ward, operation time, demographic data, and the mechanism of injury were extracted from the database.
Results
81 patients were identified who met the inclusion criteria. Median age was 56 years (range 26–64y). 64 injuries were low energy. 16 patients were alcoholics, 34 smoked cigarettes.
31 of 81 operations were performed within 12 hours of the injury. Of the delayed 50 patients, 25 sustained their injury between 1700–2359. 51 of 81 operations were performed on daytime lists (0900–1659), 23 in the evening (1700–2359) and 7 overnight (0000–0859).
Median time from injury to presentation at A&E was 1 hour 39 minutes. Time from A&E presentation to ward admission was 4 hours. Time from ward admission to surgery was 8 hours 13 minutes.
Conclusions
The time from ward admission to arrival in theatre accounted for the greatest delay, and is modifiable. Injuries which occur in the evening are often operated on the next day. The majority of the patients had low energy injuries, and a minority smoke cigarettes and abuse alcohol. The long-term implications of this delay will require further work.
