Published: 2019-08-28

Study of incidence and cause of delay for treatment of long bone fractures of the lower limb in tertiary care hospital

Elizabeth C. Sada, Firdaus Bhot, Rohit Kanishetty


Background: Musculoskeletal trauma represents a considerable global health burden. Lower limb long bone fractures are seen as a serious concern at the individual and population level. So the purpose of the study was to find incidence and cause of delay for treatment of long bone fractures of the lower limb in tertiary care hospital.

Methods: All adult patients (more than 18 years) reporting to Emergency Medicine Department of a tertiary care hospital with long bone fractures of lower limb were included in the study. Effects on the final outcome on the lifestyle of the patients were evaluated against the interventions and management at all stages of the course of the illness. Delay of surgery: in our study delay of surgery means if surgery occurs after one day (24 hours) of admission. The entire data is statistically analysed using SPSS software. P values less than 0.05 are considered to be statistically significant.

Results: 74 operated cases. 60 cases (81.10%) had delayed surgery, 14 cases (18.9.0%) did not have delayed surgery. 33 cases (55%) had medical reason for delay, 19 cases (31.7%) had financial reason for delay, 5 cases (14.3%) had infrastructure issues (unit system/non availability of implant), 3 cases (5.0%) had plan of surgery as causes of delay.

Conclusions: These factors have an effect in the final outcome of the cases. The final outcome is dependent on multiple factors. Adequate attention to each and every one of them was long way to get the patient to the pre-incident stage. 


Incidence, Cause of delay, Long bone fractures, Tertiary care hospital

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Lee C, Porter K.M. Prehospital management of lower limb fractures. Emergency Med J. 2005;22:660-3.

Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur. Database study BMJ. 2002;325(7369):868-9.

Boyd HB, Griffin LL. Classification & treatment of trochantric fracture. Arch surg. 1949;58(6):853-66.

Seinshcimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg. 1978;60(3):300-6.

Olson SA. Open fractures of tibial shaft current treatment J Bone Joint Surg Am. 1996:78(9):1428-37.

Cimino WG, Corbett ML, Leach RE. The role of closed reduction in tibial shaft fractures. Orthop Rev. 1990;19(3):233.

Giantsis Giannoulis J, Iositidis M, Getsos A, Maliou E fas L, Trains S, Tomtsis C. Long bone fractures of lower extremity. Intramedullary nailing vs other methods of osteosynthesis. J Bone Joint Surg Br. 2004;86:183.

National Institute for Clinical Excellence. Principles for best Practice in clinical audit. Oxford: Radcliffe Medical Press; 2002.

Rosner B. Fundamentals of Biostatistics, 5th ed. Duxbury; 2000: 80-240.

Riffenburg RH. Statistics in Medicine, 2nd ed. Academic Press; 2005: 85-125.

Sunder Rao P, Richard J. An Introduction to Biostatistics. A manual for students in health sciences. 4th ed. New Delhi: Prentice hall of India; 2006: 86-160.

Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291(14):1738-43.

Jindal R, Jindal N, Dass A. A retrospective study of prevalence of lower limb fractures. J Adv Med Dent Sci Res. 2016;4(6):23.

Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR. Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am. 2002;84:1605-12.

Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK. Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint Surg [Br]. 2004;86:1035-40.

Simunovic N, Devereaux PJ, Bhandari M. Surgery for hip fractures: Does surgical delay affect outcomes? Indian J Orthop. 2011;45(1):27.

Hedstrom EM, Svensson O, Bergstrom U, Michno P. Epidemiology of fractures in children and adolescents: Increased incidence over the past decade: a population-based study from northern Sweden. Acta Orthopaedica. 2010;81(1):148.