Aim : The purpose of this analysis was to
compare simple pertrochanteric fractures (PTFs) AO31-A1.2 and PTFs
with the detachment of lesser trochanter AO31-A1.3 along with the
risk factors of perioperative blood loss in terms of their impact
on postoperative level of hemoglobin.
Methods : This study analysed the clinical data of
334 unilateral, stable PTFs classified as AO31-A1.2 (205 cases) and
AO31-A1.3 (129 cases) treated with proximal femoral nail
antirotation (PFNA). First postoperative level of hemoglobin and
hemoglobin drop (difference between first on admission to hospital
and first postoperative hemoglobin levels) were chosen as the
principal outcome. Analyzed patients were not transfused between
hemoglobin measurements. Multivariate linear regression analysis
was performed to study perioperative blood loss risk factors in
patients undergoing surgery.
Results : Pertrochanteric fractures with the
detachment of lesser trochanter (AO31-A1.3) are associated with
both greater hemoglobin drop (p=0.011) and lower postoperative
hemoglobin level (p=0.078). AO31-A1.3 type of fracture is also
correlated with greater risk of postoperative blood transfusion
(p=0.038). Female were associated with lower postoperative
hemoglobin than men irrespective of the type of fracture (9.31 g/dl
vs 10.1 g/dl; p<0.0001).
Multi linear regression analysis showed that age, gender, type of
fracture, fracture gap displacement, preoperative level of
hemoglobin and angle of the fracture gap significantly affect
postoperative level of hemoglobin.
Conclusion: Despite being recognized as stable PTF
with the detachment of lesser trochanter (AO31-A1.3) is burdened
with greater risk of postoperative anemia and blood transfusion
than simple PTF (AO31-A1.2). Fracture gap displacement and angle of
fracture gap are useful predictors for lower level of postoperative
hemoglobin.