[Statistical analysis of the factors that increase perioperative bleeding in trochanteric fractures]

Abstract

Objective: The objective of this study was to determine the major risk factors for bleeding in patients with a pertrochanteric fracture in order to plan the transfusion strategy and to overcome the problem of post-surgical anaemia. Various factors were analysed, including the taking of anticoagulant and/or anti-platelet treatment, the type of fracture, type of anaesthesia, and the type of osteosynthesis used.

Material and methods: A retrospective study was performed on 307 patients over 75 years old, operated on between the years 2005 and 2009.

Results: Bleeding was less in simple, non-comminuted fractures, in patients operated on using a mini-invasive screw-plate, in women, and in patients who did not take any anticoagulant or antiplatelet treatment.The only statistically independent factor associated with bleeding was fracture comminution.

Discussion: In this study we have seen that patients operated on using a Gamma(®) and DHS(®) nail are transfused more than in those operated on using PPCP(®) and Traumax(®) plate. Evans fractures 1 or 2, A 2.2, or A 2.3, cervical-trochanteric or simple pertrochanteric fractures bled less than Evans 4 or 5, the rest of the type AO fractures, and the complex pertrochanteric fractures.

Conclusions: The precise analysis of the type of fracture is important, particularly in older and fragile patients, to be able to anticipate the need for transfusion. Thus useless and costly, and sometimes dangerous transfusions may be avoided.