Influencing factors of perioperative blood loss in intertrochanteric femoral fractures treated with intramedullary nail: a retrospective case control study

Abstract Background As society ages and the incidence of periprosthetic fractures continues to rise, hemoglobin (HGB) levels are closely associated with the incidence of perioperative complications and mortality of intertrochanteric femoral fractures (ITFs), and effective assessment of changes in HGB levels may be critical to reducing the incidence of complications and mortality. Methods We retrospectively collected clinical data of ITFs treated with PFNA at our institution. Perioperative HGB, fracture type, operation time, whether limited open reduction was used, and other general characteristics of the patients were documented. The independent risk factors causing HGB drop were studied using multiple linear regression. Results Preoperative and postoperative HGB were substantially lower in the unstable group, and HGB drop was significantly larger in the unstable group than in the stable group. The unstable group's limited open reduction rate was significantly higher than the stable group's. Age, operation time, intraoperative limited open reduction, and fracture type were all independent risk factors for HGB drop, with age being negatively connected and the rest being positively correlated. Conclusion In ITFs patients treated with PFNA, HGB drop could indicate perioperative blood loss. It is much more important to be vigilant to changes in HGB in unstable fractures and younger patients; operation time should be minimized, and unnecessary restricted open reduction should be avoided to minimise blood loss.