DELAY IN FRACTURE CARE AND POPULATION-BASED OUTCOMES IN RURAL KERALA: A MULTI-CENTRIC ORTHOPAEDIC ANALYSIS.

Abstract

Background: Timely fracture care is critical in preventing complications and ensuring optimal recovery. However, in rural India, especially in states like Kerala with a rapidly aging population, access to early orthopaedic intervention remains inconsistent.

Aim of the Study: To evaluate the factors that delay in fracture management and their outcomes across multiple rural centres in Kerala.

Methods: A multicentre cross-sectional study was conducted in three rural tertiary hospitals across northern, central, and southern districts of Kerala between January and December 2023. Data from 216 patients with fresh fractures were analyzed for time to care, reasons for delay, treatment modality, and functional outcome at 6 months using the Modified Harris Hip Score (for lower limb fractures) and DASH (Disabilities of the Arm, Shoulder, and Hand) score for upper limb fractures. Results: Among 604 patients, 55.09% reported delays exceeding 48 hours post-injury. Major causes included transportation difficulty (36.57%), referral delays from primary centres (31.48%), and financial constraints (18.05%). Patients with delayed intervention had significantly lower functional recovery scores at 6 months (p<0.01). Open fractures, elderly patients (>60 years), and those with co-morbidities were particularly vulnerable to poor outcomes.

Conclusion: Delay in fracture management in rural Kerala is substantial and significantly impacts patient recovery. Strengthening referral networks, ambulance availability, and early orthopaedic triaging at primary health levels is essential to improve fracture care outcomes.