Managing neck of femur fractures in rural hospitals

Background Neck of femur (NOF) fractures are the most common injury among elderly patients and a significant burden on our healthcare system. Aims This study aimed to evaluate if an Australian rural hospital serviced by general surgeons can meet the established standards of care for the management of NOF fractures by undertaking surgery within 48 hours. Methods An audit of patients presenting to an Australian rural hospital with NOF fractures over a seven-year period. Patients were excluded if they were transferred or suffered peri-prosthetic or multi-trauma-related fractures. Outcomes included time to surgery, length of stay, and in-hospital mortality, and were compared to three similar Australian studies from hospitals with specialist orthopaedic units. Descriptive statistics and meta-analysis were performed. Results Overall, 182 patients presented with NOF fractures and 114 met our inclusion criteria. Only 12 per cent of patients were transferred. Patients were mostly female (74 per cent) and elderly (mean age 84.0 years). A total of 79 per cent of patients were operated on within 48 hours; other studies reported 67–86 per cent. Mean length of stay was 11.9 days (versus 7.7–13.7), and in-hospital mortality was 4 per cent (versus 2–7 per cent). Conclusion This audit suggests that an Australian rural hospital serviced by general surgeons can meet the established standards of care for management of most NOF fractures. Some post-surgery outcomes are similar to those reported by larger centres with specialised orthopaedic units