ArticleBMJ open2026
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.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo 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.
designProspective cohort study.
settingA tertiary hospital in the rural Eastern Cape province of South Africa.
participants413 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.
resultsOf 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.
conclusionsSignificant 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.
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