Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative functional recovery: a random controlled trial

Abstract

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementation is beneficial for the postoperative functional recovery in elderly patients.MethodsFrom January 2007 to October 2009, 300 elderly patients with intertrochanteric fracture were enrolled into the study after screening. They were randomized into a study group receiving oral iron supplementation for 6 weeks, and a control group receiving no anti-anemic intervention. All the patients were treated with closed reduction and intramedullary fixation. Hemoglobin levels were examined and functional recovery was evaluated using the functional independence measure (FIM) method and Harris scoring system preoperation, on 1, 2 and 3 days postoperation, at discharge and the follow-ups of 1, 2, 3 and 6 months.Results A total of 79 patients were excluded because of preoperative or postoperative blood transfusion, loss to follow-up, or major complications. The remaining 114 patients in the study group and 107ones in the control group were finally analyzed. There were no significant differences in mean perioperative visible blood loss (34.4 mL versus 34. 5 mL, P ＞ 0. 05 ) between the 2 groups. Hemoglobin levels declined dramatically in the first 3 days postoperatively as compared with the preoperative values, but no difference in the declined hemoglobin levels was found among different AO fracture types ( P ＞ 0. 05). Significant differences in the increase of hemoglobin levels were found at the follow-ups of 1, 2 and 3 months between patients who received iron therapy and those who did not ( P ＜ 0. 05), but no difference was found at the follow-up of 6 months ( P ＞ 0. 05) . Similarly, the increased FIM scores at the follow-ups of 1, 2 and 3 months were significantly higher in patients with iron therapy than in those without ( P ＜ 0. 05), but no difference was found at the follow-up of 6 months ( P ＞ 0. 05). No significant difference in the Harris scores was found at any time between the 2 groups ( P ＞ 0. 05) .ConclusionsAO classification is not an independent predictor of the hidden blood loss after intertrochanteric fractures. Oral iron supplementation can effectively correct postoperative anemia and accelerate functional recovery in elderly patients. Key words: Hip fractures; Blood loss, surgical; Recovery of function; Iron