Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center

Abstract

Objective

This study investigated the delayed fixation outcomes of femoral neck fractures stratified by age and surgical delay in adult patients at a tertiary care trauma center.

Method

A retrospective study was conducted involving patients with femoral neck fractures admitted to the orthopedic ward of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma between January 2019 and March 2023. Participants aged 18–60 years who underwent delayed surgery (>48 h) were included. Data on patient demographics, fracture and surgical characteristics, and outcomes were analyzed. This study utilized chi-square or Fisher’s exact tests to compare outcomes between patients stratified by surgical delays as well as age.

Results

Among 108 participants, 63.9% were aged 18–30 years and 36.1% were aged 31–60 years. Avascular necrosis was predominantly observed in older patients who underwent surgery within 7 days (P = 0.001), whereas other complications such as nonunion and infection were more prevalent in patients aged 18–30 years whose surgery was delayed by >7 days (P = 0.303). Patients who underwent surgery within 7 days had shorter length of hospital stay and faster return to work in both age groups (P < 0.05), whereas those aged 18–30 years experienced the opposite when surgery was delayed beyond 7 days.

Conclusions

Surgical fixation within 7 days leads to better recovery and fewer complications in adults with femoral neck fractures, whereas delayed surgery provides acceptable outcomes. Age-specific protocols are key to optimizing results.

Keywords

Femoral neck fracture delayed fixation outcome age-stratified outcomes temporal analysis low-/middle-income country tertiary care trauma

Introduction

Femoral neck fracture, a common and debilitating injury, contributes to the substantial healthcare burden worldwide.^1–3 Globally, the incidence of femoral neck fractures has been rising due to an aging population and road traffic accidents, and it has been projected to accelerate dramatically in the coming decades.^1,4 These fractures pose not only clinical challenges but also substantial socioeconomic burden. Femoral neck fractures in older adults frequently result from low-energy falls, whereas those in younger individuals typically result from high-energy trauma,² with delayed surgical fixation hypothesized to contribute to increased complications, extended recovery time, and elevated mortality risk.^5–7 The timing of surgical intervention is a critical factor in determining patient outcomes, with early fixation, generally within 24–48 h of injury, being advocated to reduce complications.^2,8,9 However, in real-world settings, delays in fixation are common because of logistical, patient-related, or systemic factors. Several studies have investigated the impact of delayed surgical intervention on femoral neck fractures, with most of them suggesting that delays beyond 48 h are associated with higher complication rates and extended recovery times.^10–15 Nevertheless, there are limited data stratifying outcomes by age group, despite the fact that age is a critical determinant of both fracture pattern and physiological response to injury and surgery.^6,10,16–19 Younger patients may have better healing capacity and overall prognosis, whereas older patients with comorbidities are at greater risk of adverse outcomes, regardless of surgical delay. Considering these factors, we hypothesized that delayed fixation of femoral neck fractures have distinct outcomes in older and younger patients due to differences in healing capacity and comorbidity burden, as previously outlined in the literature.²⁰ Thus, this study aimed to analyze the delayed fixation outcomes of femoral neck fractures across two distinct adult age groups at the largest tertiary care trauma center of Pakistan, with the goal of providing clinically relevant insights that could inform age-specific and time-related surgical protocols and healthcare decision making.

Methods

Study setting, design, and period

We conducted a single-center retrospective observational study involving patients admitted to the orthopedic ward of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT) between 1 January 2024 and 1 March 2024. Ethical approval was obtained from the SMBBIT Institutional Review Board (Ref.#: ERC-000069/SMBBIT/Approval/2022). This institution was selected as it is the largest and busiest orthopedic and trauma center in Pakistan, comprising a diverse patient population presenting with fractures and trauma-related injuries.

Sample size and sampling techniques

A sample size of 163 was determined using the OpenEpi finite sample size calculator, employing the formula {n = (Z² P(1 − P))/d²} (P = incidence, d = margin of error, and Z = constant value from the standard normal distribution corresponding to a 95% confidence interval). This calculation was based on a femoral neck fracture incidence rate of 12.3%,²¹ a margin of error of 5%, and a 95% confidence interval. The sample size was then adjusted for a finite population at the selected institute using the formula n = 1 + N(n₀ − 1)n₀ (N = average number of cases per year (36), n₀ = 163), resulting in a final minimum sample size of 30. A nonprobability convenience sampling technique was employed due to the data accessibility of the target population from the busiest trauma and orthopedic institutes in Pakistan.

Inclusion and exclusion criteria

Patients aged 18–60 years with a femoral neck fracture who underwent delayed closed or open reduction and internal fixation with a cannulated hip screw (CHS) at SMBBIT, Karachi, Pakistan, between January 2019 and March 2023, with a surgical delay of >48 h and a follow-up duration of at least 12–24 months, were included in this study. Patients with a history of femoral fracture or hip surgery, metabolic disorders, lower limb deformities, and pathological fractures; those who were treated conservatively or with other fixation methods; those with polytrauma, significant intraoperative complications, active infections, and cognitive impairments; or those who were lost to follow-up before 12 months were excluded from this study.

Study tool, instrument validity, and data collection procedure

A modified and structured data evaluation form was developed in the current study, drawing upon the study by Thapa et al.²² to extract pertinent patient information (Supplementary File 1). The form was divided into three sections. Part I captured demographic data. Part II addressed fracture characteristics using the American Society of Anesthesiologists classification (ASA I: normal healthy patient, no systemic disease; ASA II: mild systemic disease that does not limit daily activities; ASA III: severe systemic disease that limits activity but is not incapacitating; ASA IV: severe systemic disease that is a constant threat to life; ASA V: moribund patient, not expected to survive beyond 24 h without surgery; and ASA VI: brain-dead patient, organ donor), Garden classification (I: incomplete, impacted fracture; II: complete, nondisplaced fracture; III: complete, partially displaced fracture; and IV: complete, fully displaced fracture), and Pauwels classification (type I: fracture line <30° from horizontal (stable); type II: fracture line 30°–50° (moderately stable); and type III: fracture line >50° (unstable, higher risk of complications)). Furthermore, the Judet point system was used for grading disability (bad = ≤8, fair = 9–11, good = 12–15, excellent = ≥16), pain (severe pain at rest = 1, severe pain on walking = 2, pain tolerable = 3, pain with fatigue = 4, slight pain = 5, no pain = 6), range of motion (0° (limb in a poor position) = 1 (bedridden), 0° (limb in a good position) = 2, 0°–70° = 3, 70°–140° = 4, 140°–200° = 5, 200°–300° = 6), and ability to walk (unable to walk = 1, very severe limp = 2, severe limp = 3, moderate limp = 4, slight limp = 5, normal walking = 6). Treatment and procedures were assessed as per Quality of Reduction (grade 1 (anatomical reduction), grade 2 (acceptable reduction), and grade 3 (poor reduction)). Part III focused on outcomes of delayed fixation. To ensure validity and relevance, the instrument was reviewed by three members of the SMBBIT Institutional Review Board (IRB) in Karachi, Pakistan. A pilot study involving 22 patients (20%) with femoral neck fractures was conducted to assess the instrument’s validity, relevance, and significance. Data from the pilot study were included in the final analysis, and patient information was sourced from the hospital’s health records.

Statistical analysis

Data were first entered into an Excel spreadsheet and subsequently imported into Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, USA) for analysis. Descriptive statistics were used to summarize patient demographics, fracture characteristics, treatments, procedures, and outcomes of delayed fixation. The chi-square or Fisher’s exact test was employed to assess differences in outcomes between surgical delays of ≤7 days and >7 days as well as between the 18–30 years and 31–60 years age groups. A P-value of <0.05 was considered to indicate statistical significance.

Ethical consideration

The study complied with the latest version of the Declaration of Helsinki on human subject research. Confidentiality was strictly maintained, with only the investigators having access to participants’ information. Given the retrospective nature of the study, a waiver for informed consent was granted by the institutional ethics committee.

Reporting of the study

The study’s reporting adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (Supplementary File 2).²³

Results

Demographic data and fracture and surgical characteristics of the participants

A total of 144 individuals with femoral neck fractures were screened, of which 108 fulfilled the inclusion criteria. Among these 108 participants, the majority were between the ages of 18 and 30 years, whereas 36.1% were between the ages of 31 and 60 years. Males constituted two-thirds of the cohort, with females comprising the remaining one-third. The largest subgroup consisted of students (44.4%; n = 48), followed by individuals from other occupational backgrounds. The majority of the participants presented with Garden IV and Pauwels III fractures, with road traffic accidents and falls contributing equally as causes of injury. Most patients underwent open reduction. Notably, 77.8% of the participants had no postoperative complications (Table 1).

Table 1.

Demographic data and fracture and surgical characteristics of participants with femoral neck fractures (N = 108).

Variables	n (%)
Age (years)
18–30	69 (63.9%)
31–60	39 (36.1%)
Sex
Male	78 (72.2%)
Female	30 (27.8%)
Occupation
Student	48 (44.4%)
Housewife	21 (19.4%)
Laborer	12 (11.1%)
Desk job	12 (11.1%)
Driver	3 (2.8%)
Retired	3 (2.8%)
Unemployed	9 (8.3%)
Comorbidities
DM	18 (16.7%)
HTN	3 (2.8%)
Chronic kidney disease	6 (5.6%)
HTN and DM	3 (2.8%)
HTN and IHD	3 (2.8%)
None	75 (69.4%)
ASA classification (grade)
I	75 (69.4%)
II	30 (27.8%)
III	3 (2.8%)
Mechanism of injury
Road traffic accident driver	30 (27.8%)
Road traffic accident pedestrian	39 (36.1%)
Fall	39 (36.1%)
Garden classification
III	15 (13.9%)
IV	93 (86.1%)
Pauwels classification
I	12 (11.11%)
II	45 (41.67%)
III	51 (47.22%)
Reduction
Open	93 (86.1%)
Close	15 (13.9%)
Quality of reduction
Grade I	93 (86.1%)
Grade II	12 (11.1%)
Grade III	3 (2.8%)
Placement of screws
Appropriate	90 (83.3%)
Inappropriate	18 (16.7%)
Length of surgical procedure (min)
<30	21 (19.4%)
30–60	57 (52.8%)
61–90	30 (27.8%)
Length of hospital stay (days)
<5	27 (25.0%)
5–10	48 (44.4%)
>10	33 (30.6%)
Complications
Avascular necrosis	9 (8.3%)
Nonunion	6 (5.6%)
Osteoarthritis	3 (2.8%)
Infection	3 (2.8%)
Implant failure	6 (5.6%)
Deep venous thrombosis	0 (0%)
None	81 (75.0%)
Delay in surgery (days)
≤7	75 (69.4%)
>7	33 (30.6%)
Time to union (weeks)
<12	27 (25%)
12–16	78 (72.2%)
>16	3 (2.8%)
Return to work (weeks)
<4	9 (8.3%)
4–8	78 (72.2%)
>8	21 (19.4%)

DM: diabetes mellitus; HTN: hypertension; IHD: ischemic heart disease.

Delayed fixation outcomes of femoral neck fractures stratified by temporal variation

Among the 108 patients with femoral neck fractures, significant differences were observed between those who underwent surgery within 7 days (early surgery group) and those whose surgery was delayed beyond 7 days (delayed surgery group). Notably, avascular necrosis (AVN) occurred in the early surgery group, whereas no cases were reported in the delayed surgery group. Furthermore, the incidence of other complications was slightly higher in the delayed surgery group than in the early surgery group (P = 0.000). In terms of length of hospital stay, most patients in the early surgery group were discharged between 5 and 10 days postoperatively, with a smaller number of patients discharged within <5 days. Conversely, almost all patients in the delayed surgery group were discharged more than 10 days after surgery (P = 0.000). Regarding the time to fracture union and return to work following discharge, both metrics exhibited similar trends favoring the early surgery group. Furthermore, 68% of patients in the early surgery group achieved excellent disability scores compared with 45.5% in the delayed surgery group; however, this difference did not reach statistical significance (Table 2).

Table 2.

Outcome of delayed fixation of femoral neck fracture stratified by temporal variation (N = 108).

Variables	Delay in surgery (days)		P-value (chi-square)
Variables	≤7	>7	P-value (chi-square)
Surgical complications
Avascular necrosis	9 (12%)	0 (0%)	0.000 (20.55)
Nonunion	3 (4.0%)	3 (9.1%)
Osteoarthritis	0 (0%)	3 (9.1%)
Infection	0 (0%)	3 (9.1%)
Implant failure	3 (4%)	3 (9.1%)
Deep venous thrombosis	0 (0%)	0 (0%)
None	60 (80%)	21 (63.6%)
Length of hospital stay (days)
<5	27 (36.0%)	0 (0%)	0.000 (81.893)
5–10	45 (60.0%)	3 (9.1%)
>10	3 (4.0%)	30 (90.9%)
Time to union (weeks)
<12	21 (28.0%)	6 (18.2%)	0.021 (7.703)
12–16	54 (72.0%)	24 (72.7%)
>16	0 (0%)	3 (9.1%)
Return to work (days)
<4	9 (12.0%)	0 (0%)	0.003 (11.441)
4–8	57 (76.0%)	21 (63.6%)
>8	9 (12.0%)	12 (36.4%)
Disability (Judet scoring)
Bad	3 (4.0%)	3 (9.1%)	0.141 (5.462)
Fair	6 (8.0%)	3 (9.1%)
Good	15 (20.0%)	12 (36.4%)
Excellent	51 (68.0%)	15 (45.5%)

Note: Judet scoring for disability: Bad = ≤8, Fair = 9–11, Good = 12–15, Excellent = ≥16.

Judet point system for grading disability:

Pain: severe pain at rest = 1, severe pain on walking = 2, pain tolerable = 3, pain with fatigue = 4, slight pain = 5, no pain = 6.

Range of motion: 0° (limb in a poor position) = 1 (bedridden), 0° (limb in a good positon) = 2, 0°–70° = 3, 70°–140° = 4, 140°–200° = 5, 200°–300° = 6.

Ability to walk: unable to walk = 1, very severe limp = 2, severe limp = 3, moderate limp = 4, slight limp = 5, normal walking = 6.

Age-stratified outcome of delayed fixation of femoral neck fractures

Among the 108 patients with femoral neck fractures, age-stratified analysis revealed significant differences in surgical outcomes based on the timing of surgery. In the 18–30 years age group, no cases of AVN were reported among those who underwent surgery within 7 days, whereas 25% of AVN cases were identified in the 31–60 years age group who underwent surgery within the same timeframe. Furthermore, the incidence of other surgical complications was higher among patients in the 18–30 years age group who underwent surgery after 7 days, whereas no complications were observed among patients in the 31–60 years age group who underwent surgery within the same timeframe. In terms of length of hospital stay, patients in both age groups who underwent surgery within 7 days had comparable lengths of stay. However, those aged 18–30 years who underwent surgery after 7 days experienced a longer hospital stay than those aged 31–60 years who underwent surgery within 7 days. Regarding time to fracture union, return to work, and disability outcomes, both age groups exhibited similar patterns, regardless of whether surgery was performed within 7 days or after 7 days. The time to fracture union ranged from 12 to 16 weeks, with patients returning to work within 4–8 days after discharge. The majority of patients in both age groups demonstrated excellent recovery, with no reported disability, irrespective of the timing of surgery (Table 3).

Table 3.

Age-stratified outcome of delayed fixation of femoral neck fracture (N = 108).

Variables	Delay in surgery (days)
	≤7		>7
	Age (years)
	18–30	31–60	18–30	31–60
Surgical complications
Nonunion	3 (7.7%)	0 (0%)	3 (10%)	0 (0%)
Avascular necrosis	0 (0%)	9 (25.0%)	0 (0%)	0 (0%)
Osteoarthritis	0 (0%)	0 (0%)	3 (10%)	0 (0%)
Infection	0 (0%)	0 (0%)	3 (10%)	0 (0%)
Implant	3 (7.7%)	0 (0%)	3 (10%)	0 (0%)
Deep venous thrombosis	0 (0%)	0 (0%)	0 (0%)	0 (0%)
None	33 (84.6%)	27 (75%)	18 (60%)	3 (100%)
P-value (chi-square)	0.001 (15.505)		0.303 (1.886)
Length of hospital stay (days):
<5	21 (53.8%)	6 (16.7%)	0 (0%)	0 (0%)
5–10	15 (38.5%)	30 (83.3%)	3 (10.0%)	0 (0%)
>10	3 (7.7%)	0 (0%)	27 (90%)	3 (100%)
P-value (chi-square)	0.000 (16.239)		0.566 (0.330)
Time to union (weeks):
<12	9 (23.1%)	12 (33.3%)	6 (20%)	0 (0%)
12–16	30 (76.9%)	24 (66.7%)	21 (70%)	3 (100%)
>16	0 (0%)	0 (0%)	3 (10%)	0 (0%)
P-value (chi-square)	0.323 (0.977)		0.539 (1.238)
Return to work (days):
<4	6 (15.4%)	3 (8.3%)	0 (0%)	0 (0%)
4–8	33 (84.6%)	24 (66.7%)	18 (60%)	3 (100%)
>8	0 (0%)	9 (25%)	12 (40%)	0 (0%)
P-value (chi-square)	0.003 (11.319)		0.170 (1.886)
Disability (Judet scoring)
Bad	3 (7.7%)	0 (0%)	3 (10%)	0 (0%)
Fair	0 (0%)	6 (16.7%)	3 (10%)	0 (0%)
Good	9 (23.1%)	6 (16.7%)	12 (40%)	0 (0%)
Excellent	27 (69.2%)	24 (66.7%)	12 (40%)	3 (100%)
P-value (chi-square)	0.022 (9.672)		0.266 (3.960)

Note: Judet scoring for disability: Bad = ≤8, Fair = 9–11, Good = 12–15, Excellent = ≥16.

Judet point system for grading disability:

Pain: severe pain at rest = 1, severe pain on walking = 2, pain tolerable = 3, pain with fatigue = 4, slight pain = 5, no pain = 6.

Range of motion: 0° (limb in a poor position) = 1 (bedridden), 0° (limb in a good positon) = 2, 0°–70° = 3, 70°–140° = 4, 140°–200° = 5, 200°–300° = 6.

Ability to walk: unable to walk = 1, very severe limp = 2, severe limp = 3, moderate limp = 4, slight limp = 5, normal walking = 6.

Discussion

This study sought to investigate the age-stratified and temporally stratified outcomes of delayed fixation of femoral neck fractures in a low-/middle-income setting, focusing on adults treated at a tertiary trauma center. Our findings demonstrated that delaying surgery beyond 7 days was associated with an increased risk of complications, longer hospital stays, and prolonged recovery times. These results contribute to the expanding body of evidence underscoring the adverse effects of delayed surgical intervention, especially in low-/middle-income countries where healthcare access and infrastructure challenges may exacerbate these delays.^24–26

One of the key findings of our study is the higher incidence of AVN in patients who underwent surgery within 7 days for femoral neck fractures. This is consistent with the findings from previous studies indicating that patients who undergo surgical intervention 24 h to 7 days after injury, although generally beneficial, have higher AVN rates.^27–28 This phenomenon may be attributed to the fact that surgical intervention within 48 h to 7 days can increase the risk of AVN due to the already compromised blood supply to the femoral neck following the fracture, and performing surgery during this critical period may further damage vascular structures and impede the formation of collateral blood flow, which is essential for revascularization.^29–30 Such disruption can obstruct the natural healing process, thereby increasing the likelihood of AVN. Moreover, AVN was exclusively observed among patients in the 31–60 years age group who underwent surgery within 7 days post-fracture. Factors such as altered vascular supply and diminished bone healing capacity associated with aging, combined with a higher incidence of trauma in this active age group, may contribute to the risk, and surgical delays further complicate healing processes, thereby increasing the likelihood of AVN.^31–32

Additionally, our study revealed that complications such as nonunion, osteoarthritis, and infection were more prevalent in patients whose surgery was delayed by >7 days, with younger patients disproportionately affected, which is in line with studies by Hua et al.¹⁸ and Thapa et al.²² However, our results are contradictory to those of Hapuarachch et al.,³³ who reported higher complication rates in older patients with a surgical delay of >7 days for femoral neck fractures. The similarities and discrepancies might be attributed to the higher rates of high-energy trauma, such as road traffic accidents, evidenced within our study population, particularly among younger individuals. The interplay between trauma severity, surgical delays, and patient age is complex³⁴; however, our findings suggest that younger patients with delayed surgery are at higher risk of complications due to the nature of their injuries.

Moreover, the extended hospital stay in the delayed surgery group highlights the impact of surgical delays, as patients in both age groups who underwent surgery within 7 days were more likely to be discharged within 10 days than those with a surgical delay of >7 days and who required longer hospitalization, which is consistent with the literature.^13,18 Patients who underwent surgery within 7 days exhibited shorter hospital stays; this may be due to their better physiological stability, which promotes efficient recovery and timely discharge, while delays beyond 7 days can exacerbate conditions, increase anxiety, and lead to comorbidities, thereby prolonging hospitalization.^35–37

Furthermore, patients who underwent surgical intervention within 7 days demonstrated superior outcomes regarding their return to work, with most of them resuming their jobs within 4–8 weeks post-surgery, whereas those with a surgical delay of >7 days showed prolonged recovery times, especially younger individuals. Accelerated postoperative recovery due to enhanced physiological resilience, fewer comorbidities, increased motivation to resume activities, and greater benefits from advancements in surgical techniques are further supported by a better physical condition and positive psychological outlook among younger adults.³⁸

A comparison of our findings of delayed fixation of femoral neck fractures with those of a prior study on early fixation by Gumustas et al. indicated that delayed fixation is as effective as early fixation in achieving favorable outcomes.³⁹ Our study demonstrated that patients who underwent delayed fixation for femoral neck fractures did not experience a significant increase in complications or adverse effects compared with those receiving early fixation. This suggests that delayed fixation can be a viable option, particularly in low-/middle-income countries where delayed surgery is more likely to occur due to resource constraints and logistical challenges, contributing to a growing body of evidence that challenges the conventional preferences.

Several limitations should be noted. First, our study was conducted at a single center, which may limit the generalizability of the findings; however, this limitation was mitigated by selecting the largest trauma center in Pakistan for the research. Second, the retrospective nature of the study may have introduced selection bias, as patients with more severe injuries or complications were more likely to undergo delayed surgery. The use of convenience sampling may also limit the representativeness of the sample. Third, by using CHS exclusively in our study, we acknowledge the ongoing debate regarding fixation methods, particularly in younger to relatively older adults. No significant differences in healing or complications were observed between different fixation methods in recent studies, although CHS yielded superior Hip Disability and Osteoarthritis Outcome Scores, suggesting functional benefits.⁴⁰ These findings support CHS as a reliable option for preserving the native hip in younger adults undergoing delayed fixation. Given the challenges of delayed surgery in resource-limited settings, further research should explore the impact of fixation techniques on outcomes, particularly in delayed interventions, to optimize treatment strategies and enhance patient recovery. Finally, we could not control for certain confounding factors, such as the variability in surgeon expertise and postoperative care, which may have influenced the outcomes.

Conclusion

Our findings emphasize the urgent need to address the issue of delayed surgical fixation of femoral neck fractures in low-/middle-income settings such as Karachi, Pakistan. The data revealed that delays in surgical intervention within or beyond 7 days or different age groups did not significantly exacerbate complication rates, indicating that delayed fixation can be a viable option in resource-limited environments. Notably, patients who underwent surgery within 7 days, particularly younger individuals, demonstrated slightly improved recovery times, such as shorter hospital stays and quicker return to work, highlighting the importance of timely intervention, although the differences were not substantial compared with those of patients who had surgery after 7 days and those aged 31–60 years. This study provides valuable insights to the existing literature, suggesting that although early fixation is generally advantageous, delayed surgical fixation of femoral neck fractures may also lead to acceptable outcomes, challenging the conventional belief that immediate surgery is the only path to successful recovery. Our results lay the groundwork for future research to further explore these dynamics and optimize surgical protocols in similar healthcare contexts.

Supplemental Material

sj-pdf-1-imr-10.1177_03000605251336110 - Supplemental material for Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center

Supplemental material, sj-pdf-1-imr-10.1177_03000605251336110 for Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center by Muhammad Gulfam Shahzad, Muhammad Hamza Dawood, Kazim Hussain, Shakeel Gul, Syed Akmal Sultan and Musab Zarar in Journal of International Medical Research

Supplemental Material

sj-pdf-2-imr-10.1177_03000605251336110 - Supplemental material for Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center

Supplemental material, sj-pdf-2-imr-10.1177_03000605251336110 for Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center by Muhammad Gulfam Shahzad, Muhammad Hamza Dawood, Kazim Hussain, Shakeel Gul, Syed Akmal Sultan and Musab Zarar in Journal of International Medical Research

Footnotes

Acknowledgements

None.

Authors contributions

MGS is the guarantor of the study. MGS and MHD are the first authors. The contributions of each author are as follows: MGS: Research proposal, study design, data collection, drafting, and supervision; MHD: Research proposal, study design, drafting, analysis, and critical revision; KH and SAS: drafting and critical revision; and SG and MZ: data collection, interpretation, and visualization. All authors have approved the final version of the article.

Author’s note

MGS and MHD are the first authors of the study and have contributed equally.

Consent

The need for written informed consent was waived off by the SMBBIT as the study data were collected from hospital records.

Data availability statement

The datasets analyzed in this study are not publicly available. De-identified data are available upon reasonable request to the lead or corresponding author.

Declaration of conflicting interest

The authors declare that there is no conflict of interest.

Ethical approval

The study was approved by the IRB-Committee of SMBBIT, Karachi, Pakistan (Ref. No: ERC-000069/SMBBIT/Approval/2022).

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

ORCID iD

Muhammad Hamza Dawood

Supplementary material

Supplemental material for this article is available online.

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