Clinical analysis of peri-operative hidden blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation

Li, Bohua; Li, Jun; Wang, Shanxi; Лю, Лэй

doi:10.1038/s41598-018-21703-4

Cited by 25 publications

(22 citation statements)

References 23 publications

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“…Hip fractures can result in obvious blood loss; more specifically, patients with ITFs may have an underestimated blood loss, which increases postsurgical morbidity [5][6][7]. However, initial hematocrit (Hct) or hemoglobin (Hb) screening may seem normal on admission of these patients to the emergency department [5][6][7]. The accurate estimation of hidden blood loss may predict the Hb drop after fracture fixation, which could potentially improve the overall survival of patients with ITF.…”

Section: Introductionmentioning

confidence: 99%

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Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2020

BMC Musculoskelet Disord

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Background: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop. Methods: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre-and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants. Results: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05). Conclusions: Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality.

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Section: Introductionmentioning

confidence: 99%

“…Risk factors that may have an impact on hidden blood loss, such as age, presence of an unstable fracture, intramedullary fixation, and general anesthesia, have been reported [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2020

BMC Musculoskelet Disord

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“…A few literatures showed that the postoperative hidden blood loss is more than intra-operative blood loss. [45][46][47] Unfortunately, this presented meta-analysis didn't analyze the hidden blood loss. Therefore, only analyzing intraoperative blood loss may be unfair for the AR group.…”

Section: Operative Time Blood Loss and Transfusionmentioning

confidence: 99%

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Yu¹,

Lu²,

Xiao³

et al. 2020

Preprint

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Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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“…Hip fractures can result in obvious blood loss; more specifically, patients with ITFs may have an underestimated blood loss, which increases postsurgical morbidity (4)(5)(6). Initial hematocrit or hemoglobin screening may be normal when these patients are admitted to the emergency department (4)(5)(6). The accurate estimation of hidden blood loss may predict the hemoglobin drop after fracture fixation, which could potentially improve the overall survival of patients with ITF.…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors that may have an impact on hidden blood loss, such as age, presence of an unstable fracture, intramedullary fixation, and general anesthesia, have been reported (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

Clinical analysis of peri-operative hidden blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation

Cited by 25 publications

References 23 publications

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

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