Comparison of postoperative hidden blood loss and deep venous thrombosis between dynamic hip screw, InterTan and proximal femoral nail antirotation-II in treatment of femoral intertrochanteric fracture

Abstract

Objective To compare dynamic hip screw (DHS), InterTan and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the treatment of femoral intertrochanteric fracture in terms of their effects on postoperative hidden blood loss (HBL) and deep venous thrombosis (DVT). Methods We retrospectively analyzed the 133 patients with femoral intertrochanteric fracture who had been treated in our hospital from November 2011 to November 2015. Of them, 42 received DHS treatment, including 22 males and 20 females; 43 underwent InterTan fixation, including 21 males and 22 females; 48 had PFNA-Ⅱ treatment, including 25 males and 23 females. At preoperation, 1, 3 and 7 days postoperation, all of them had tests of hemoglobin (Hb), hematocrit value (Hct), blood platelet (PLT), thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), human fibrinogen (FIB) and D-dimer. DVT was detected using color Doppler ultrasound at 7 days postoperation. Results At 1, 3 and 7 days postoperation, the DHS patients had the smallest values of Hb, Hct, TT, PT and APTT while the PFNA-Ⅱ patients the largest. The DHS patients had the largest values of intraoperative bleeding, PLT, FIB and D-dimer while the PFNA-Ⅱ patients the smallest. There were significant differences between the 3 groups in all the indexes (P 0.05). The incidence of DVT in the InterTan group (2.3%, 1/43) and in the PFNA-Ⅱ group (0) was significantly lower than in the DHS group (7.1%, 3/42) (P<0.05). Conclusion In the treatment of femoral intertrochanteric fracture, PFNA-Ⅱ may be superior to InterTan and DHS in reducing postoperative HBL and control of DVT. Key words: Hip fractures; Fracture fixation, internal; Bone nails; Postoperative hemorrhage; Embolism and thrombosis