Abstract
BackgroundThe purpose of this study was to evaluate whether PFNA-II (Asia proximal femoral nail anti-rotation) and DHS (dynamic hip screw) carry substantial post-operative hidden blood loss and to compare PFNA-II with DHS in terms of post-operative hidden blood loss in elderly high-risk patients with intertrochanteric femur fractures(IFFs).MethodsThe clinical data from Jan 2005 to Apr 2015 of 186 patients with PFNA-II and 177 patients with DHS were analyzed retrospectively. Indexes including pre- and post-operative blood routine, intra- and post-operative blood loss and blood transfusion situation were analyzed. The situation of perioperative blood loss (visible and hidden) was assessed.ResultsThe intra-operative blood loss in the PFNA-II group was 34.7 ± 2.5 ml, the post-operative visible blood loss was 54.7 ± 2.5 ml, and the hidden blood loss was 277.2 ± 7.6 ml. In the DHS group, the intra-operative blood loss was 102.0 ± 7.0 ml, the post-operative visible blood loss was 78.8 ± 4.7 ml, and the hidden blood loss was 139.3 ± 9.6 ml. The intra-operative blood loss and the post-operative visible blood loss in the PFNA-II group were significantly less than in the DHS group (p < 0.01). However, the post-operative hidden blood loss and the total blood loss in the PFNA-II group were larger than in the DHS group (p < 0.01).ConclusionThis study demonstrated that with PFNA-II and DHS, much post-operative hidden blood loss exists in the treatment of intertrochanteric fractures in elderly high-risk patients and DHS is more favourable than PFNA-II in terms of post-operative hidden blood loss.
Highlights
The purpose of this study was to evaluate whether PFNA-II (Asia proximal femoral nail anti-rotation) and dynamic hip screw (DHS) carry substantial post-operative hidden blood loss and to compare PFNA-II with DHS in terms of post-operative hidden blood loss in elderly high-risk patients with intertrochanteric femur fractures(IFFs)
The frequency distribution of the total blood loss measurements was that its concentration appeared as a clearly centralized distribution in both groups: in Group PFNA-II, most of the values are approximately 368 ml, whereas in Group DHS, the values were approximately 320 ml (Fig. 3)
The visible blood loss post-operation for 186 patients was an average of 89.4 ± 4.0 ml; the hidden blood loss was an average of 277.2 ± 7.6 ml
Summary
The purpose of this study was to evaluate whether PFNA-II (Asia proximal femoral nail anti-rotation) and DHS (dynamic hip screw) carry substantial post-operative hidden blood loss and to compare PFNA-II with DHS in terms of post-operative hidden blood loss in elderly high-risk patients with intertrochanteric femur fractures(IFFs). The most common options are either the dynamic hip screw (DHS) or Asia proximal femoral nail anti-rotation (PFNAII) [10]. PFNA-II can minimize the risk of these implant-related complications and provide angular and rotational stability. This is especially important in osteoporotic bone and unstable IFFs of elderly high-risk patients, allowing early mobilization and weight bearing on the affected limbs [15,16,17,18]. There is no definitive conclusion far on which fixation method is optimal for elderly high-risk patients with IFFs in reducing hidden blood loss and improving prognosis
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