Hidden blood loss between PCCP and PFNA in elderly femoral intertrochanteric fracture

Abstract

To compare perioperative hidden blood loss in the treatment of femoral intertrochanteric fractures with percutaneous compression plate (PCCP) and proximal femoral nail anti-rotation (PFNA) in elderly patients, and analyse its influencing factors in order to provide the necessary data support for clinical perioperative treatment, and choice of appropriate internal fixation method. Retrospective analyses was carried out on data obtained from 158 patients with intertrochanteric fracture treated with PCCP or PFNA from January 2010 to May 2017. Data were obtained from variables such as age, gender, height, weight, operative bleeding and postoperative drainage, operation time, etc. Upon blood routine examination before and after surgery (RBC, Hb and Hct), total and hidden blood losses were calculated using Gross equations. A comparative analysis was carried out on the differences in hidden blood loss, postoperative complications and prognosis between PCCP and PFNA.Visible blood loss was higher in PCCP than in PFNA, but total and hidden blood losses were significantly lower in PFNA(P<0.05). Within the two groups, hidden blood loss in elderly patients was significantly higher (P<0.05). Start time of weight-bearing of PCCP group was significantly longer than of PFNA group (P<0.05), but incidences of complications of important organs and perioperative mortality in PCCP group were significantly lower than those of PFNA group (P<0.05). There were no significant differences in operation time, infection of incision, failure of internal fixation, fracture healing time, or Harris function score of half year after operation between the two groups (P<0.05). There is serious hidden blood loss before and after operation in elderly patients with femoral intertrochanteric fractures, of which intramedullary fixation is higher. Intramedullary fixation causes more severe complications of important organs than extramedullary fixation.

Keywords: Percutaneous compression plate, proximal femoral anti-rotation nail, femoral intertrochanteric fractures, hidden blood loss.