RISK FACTORS OF HIDDEN BLOOD LOSS IN INTERNAL FIXATION OF INTERTROCHANTERIC FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGYiling , SHENJing , MAOZhi , LONGAnhua , ZHANGLihai ,  TANGPeifu

Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

TANGPeifu, Email: tangpeifu301@gmail.com

Keywords：

Intertrochanteric fracture; Hidden blood loss; Risk factor

DOI：

10.7507/1002-1892.20140136

Video：

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Objective To analyze the associated risk factors of hidden blood loss in the internal fixation of intertrochanteric fracture. Methods A retrospective analysis was made on the clinical data of 317 cases of intertrochanteric fractures which were treated by internal fixation between January 1993 and December 2008. There were 154 males and 163 females with an average disease duration of 4.58 days (range, 7 hours to 33 days); the age was (69.86±15.42) years; the average height was 1.64 m (range, 1.50-1.84 m);and the average weight was 62.26 kg (range, 39-85 kg). Of them, intramedullary fixation was used in 203 patients and extramedullary fixation in 114 patients. The operation time was (61.99±18.25) minutes. The red blood cell transfusion was given to 84 patients, and the transfusion amount was 200-1 000 mL. The drainage volume was 0-750 mL (mean, 61.85 mL). Hidden blood loss was calculated through change of hematocrit level before and after operation. The multiple linear regression was performed to analyse the risk factors of hidden blood loss. Results The total blood loss was (918.60±204.44) mL, the hidden blood loss was (797.77±192.58) mL, and intraoperative visible blood loss was (257.32±271.24) mL. Single factor analysis showed hidden blood loss was significantly higher in variables as follows:gender, age, injury cause, fracture type, American anesthesiologists grading, anesthesia mode, hypertension, diabetes, disease duration, operation time, intraoperative transfusion of red blood cells, and fixation type. Multiple linear regression showed age, fracture type, anesthesia mode, and fixation type were significant risk factors. Conclusion The risk factors of hidden blood loss are advanced age (>60 years), unstable fracture, general anesthesia, and imtramedullary fixation. Especially in elder patients with unstable fracture treated by intramedullary fixation under general anesthesia, hidden blood loss is more significant.

Citation： ZHANGYiling, SHENJing, MAOZhi, LONGAnhua, ZHANGLihai, TANGPeifu. RISK FACTORS OF HIDDEN BLOOD LOSS IN INTERNAL FIXATION OF INTERTROCHANTERIC FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 610-614. doi: 10.7507/1002-1892.20140136 Copy

1.	Taylor AJ, Gary LC, Arora T, et al. Clinical and demographic factors associated with fractures among older Americans. Osteoporos Int, 2011, 22(4):1263-1274.
2.	Kaplan K, Miyamoto R, Levine BR, et al. Surgical management of hip fractures:an evidence-based review of the literature. Ⅱ:intertrochanteric fractures. J Am Acad Orthop Surg, 2008, 16(11):665-673.
3.	Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures:changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am), 2008, 90(4):700-707.
4.	Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg (Br), 2006, 88(8):1053-1059.
5.	Ostojić Z, Moro G, Kvesić A, et al. Treatment of peritrochanteric fractures by the use of gamma nail. Coll Antropol, 2010, 34 Suppl 1:243-246.
6.	Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures:gliding screw-plating vs intramedullary nailing. Injury, 2010, 41(3):279-284.
7.	Xu YZ, Geng DC, Mao HQ, et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4):1266-1275.
8.	Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture. Injury, 2011, 42(2):133-135.
9.	Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg (Br), 2004, 86(4):561-565.
10.	Kropfl A, Berger U, Neureiter H, et al. Intramedullary pressure and bone marrow fat intravasation in unreamed femoral nailing. J Trauma, 1997, 42(5):946-954.
11.	Kropfl A, Davies J, Berger U, et al Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing. J Orthop Res, 1999, 17(2):261-268.
12.	Whitenack SH, Hausberger FX. Intravasation of fat from the bone marrow cavity. Am J Pathol, 1971, 65(2):335-345.
13.	Dimeski G, Mollee P, Carter A. Increased lipid concentration is associated with increased hemolysis. Clin Chem, 2005, 51(12):2425.
14.	Cooper RA. Abnormalities of cell-membrane fluidity in the pathogenesis of disease. N Engl J Med, 1977, 297(7):371-377.
15.	Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3):151-155.
16.	Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology, 1974, 41(6):609-612.
17.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surg, 1962, 51(2):224-232.
18.	侯国进, 周方, 张志山, 等. 不同内固定方式治疗老年股骨粗隆间骨折围手术期的失血特点分析. 北京大学学报:医学版, 2013, 45(5):738-741.
19.	张培训, 薛峰, 安帅, 等. 股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的显性和隐性失血量分析. 北京大学学报:医学版, 2013, 45(6):891-894.

1. Taylor AJ, Gary LC, Arora T, et al. Clinical and demographic factors associated with fractures among older Americans. Osteoporos Int, 2011, 22(4):1263-1274.
2. Kaplan K, Miyamoto R, Levine BR, et al. Surgical management of hip fractures:an evidence-based review of the literature. Ⅱ:intertrochanteric fractures. J Am Acad Orthop Surg, 2008, 16(11):665-673.
3. Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures:changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am), 2008, 90(4):700-707.
4. Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg (Br), 2006, 88(8):1053-1059.
5. Ostojić Z, Moro G, Kvesić A, et al. Treatment of peritrochanteric fractures by the use of gamma nail. Coll Antropol, 2010, 34 Suppl 1:243-246.
6. Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures:gliding screw-plating vs intramedullary nailing. Injury, 2010, 41(3):279-284.
7. Xu YZ, Geng DC, Mao HQ, et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4):1266-1275.
8. Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture. Injury, 2011, 42(2):133-135.
9. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg (Br), 2004, 86(4):561-565.
10. Kropfl A, Berger U, Neureiter H, et al. Intramedullary pressure and bone marrow fat intravasation in unreamed femoral nailing. J Trauma, 1997, 42(5):946-954.
11. Kropfl A, Davies J, Berger U, et al Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing. J Orthop Res, 1999, 17(2):261-268.
12. Whitenack SH, Hausberger FX. Intravasation of fat from the bone marrow cavity. Am J Pathol, 1971, 65(2):335-345.
13. Dimeski G, Mollee P, Carter A. Increased lipid concentration is associated with increased hemolysis. Clin Chem, 2005, 51(12):2425.
14. Cooper RA. Abnormalities of cell-membrane fluidity in the pathogenesis of disease. N Engl J Med, 1977, 297(7):371-377.
15. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3):151-155.
16. Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology, 1974, 41(6):609-612.
17. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surg, 1962, 51(2):224-232.
18. 侯国进, 周方, 张志山, 等. 不同内固定方式治疗老年股骨粗隆间骨折围手术期的失血特点分析. 北京大学学报:医学版, 2013, 45(5):738-741.
19. 张培训, 薛峰, 安帅, 等. 股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的显性和隐性失血量分析. 北京大学学报:医学版, 2013, 45(6):891-894.

Chinese Journal of Reparative and Reconstructive Surgery

RISK FACTORS OF HIDDEN BLOOD LOSS IN INTERNAL FIXATION OF INTERTROCHANTERIC FRACTURE

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