Length of Hospitalization for Internal Fixation of Femur Fracture
The typical length of acute inpatient stay for femur fracture requiring internal fixation ranges from 8 to 30 days, with a mean of 16 days and a median of 6.4 days, depending on patient age, comorbidities, and fracture complexity. 1, 2
Expected Hospital Stay by Patient Population
Hip/Proximal Femur Fractures (Elderly Patients)
- Mean length of stay: 16 days (range 8-30 days) for hip fractures in older adults 1
- Median postoperative stay: 23 days in England for hip fracture patients 1
- The rehabilitation process constitutes the majority of the inpatient stay after hip fracture, as patients require multidisciplinary input from physiotherapists, occupational therapists, and social workers 1
Femoral Shaft Fractures (Younger Trauma Patients)
- Median length of stay: 6.43 days (range 1-76 days) for operatively treated femur fractures in trauma patients 2
- Patients with length of stay ≥6 days represent approximately 53% of femur fracture cases 2
Key Factors That Extend Hospital Stay
Patient-Related Factors
- Frailty increases risk 20-fold for staying longer than 6 days after femur fracture (OR 20.58) 2
- Medical complications increase risk 20-fold for extended stay (OR 20.09) 2
- Advanced age (particularly ≥86 years) correlates with longer hospitalization 3
- Injury Severity Score independently predicts length of stay (OR 1.14 per point increase) 2
Injury-Related Factors
- Associated injuries significantly extend stay:
- Polytrauma patients with ISS ≥15 require longer hospitalization for stabilization 4
Treatment-Related Factors
- Delayed time to definitive fixation increases length of stay (OR 2.12) 2
- Delayed first physical therapy visit extends hospitalization (OR 1.77) 2
- Surgery should ideally occur within 24-48 hours of admission unless reversible medical conditions exist 1
Discharge Planning Considerations
Discharge Destinations
- Only 44% of hip fracture patients admitted from home are discharged back to their own homes within 30 days of surgery 1
- 22% are discharged to residential or nursing homes, which can prolong discharge waiting times 1
- Pre-operative management should include early consideration of discharge planning to reduce delays 1
Common Pitfalls to Avoid
- Failing to identify frail patients early: Patients meeting Modified Frailty Index criteria have a 20-fold increased risk of extended stay and require proactive discharge planning from admission 2
- Delaying physical therapy: Time to first PT visit independently predicts length of stay, so mobilization should begin as soon as medically safe 2
- Inadequate nutritional support: Up to 60% of hip fracture patients are malnourished on admission, and nutritional supplementation may reduce length of stay 1
- Prolonged surgical delay without justification: While severely injured polytrauma patients (ISS ≥26) may benefit from 12-24 hour delay for resuscitation, delays beyond 48 hours increase mortality risk in isolated femur fractures 5