Paediatric femoral fractures: factors influencing length of stay and readmission rate

AIM: This report describes factors influencing length of stay and unplanned readmissions within 30 days of discharge for children presenting with femoral fractures to Starship Hospital. METHODS: The charts and radiographs of all children admitted with femoral shaft fractures between January 1998 and December 2002 were reviewed, excluding pathological fractures. The type of management, the length of stay and the unexpected readmission rate within 30 days were recorded. Ninety-three children with 95 femoral fractures were included in the study. RESULTS: Forty-six fractures were treated by application of immediate hip spica and 49 by other surgical methods (21 by external fixation, 20 by flexible intramedullary nailing and 8 by other methods). Patients with isolated femur fractures treated by either hip spica application or other operative fixation had median lengths of stay of 3 days (range 1-10 days) and 6 days (range 2-15 days), respectively. Patients with associated injuries, whose femur fractures were treated by either hip spica application or other operative fixation, had longer median lengths of stay of 5 days (3-15 days) and 17 days (5-70 days), respectively. Nine of the 93 children had an unplanned return to the operating theatre during their initial hospital stay, with increased length of stay in 5 as a result. A further 21 children were readmitted within 30 days of discharge with problems of loss of fracture alignment and cast damage in the hip spica group; pin-site infections in the external fixation group and pain around the distal nail insertion site in the flexible intramedullary nailing group. Despite these early problems, fracture alignment was satisfactory at union in 89 of the 95 fractures, with satisfactory remodelling in the remaining six fractures at follow-up. CONCLUSIONS: The presence of associated injuries was a key factor in the length of the initial hospital stay. However, the need for further operative interventions in the first hospital stay also increased the length of stay in some patients. Overall, the operative management of femoral fractures is resource intensive with a significant need for further minor operative intervention, regardless of the type of initial management.