Hidden blood loss in hip fractures

G. H. Smith, Jerry Tsang, Samuel Molyneux, Tim White

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AbstractIntroduction: Despite advances in surgical and anaesthetic techniques the mortality after hip fracture has not significantly changed in the last 40 years. Pre-operative anaemia is a risk factor for peri-operative death.We speculate that a significant proportion of the blood loss related to hip fracture has occurred prior to surgery. Identifying patients at risk of pre-operative anaemia can facilitate appropriate medical optimisation. This study is unique in its attempt to quantify the blood loss associated with the initial hip injury.Methods: In a retrospective study over 12 months all patients with both a diagnosis of hip fracture and an operative delay of >48 hours were assessed. The information collected included: fracture classification, serial haemoglobins and patient comorbidities. The exclusion criteria included a pre-injury diagnosis of anaemia and gastrointestinal bleeds.Results: 68 intracapsular and 50 extracapsular hip fracture patients had serial haemoglobins and operative delays of >48hrs (mean 75hrs, range 48–270hrs).The mean lowest recorded haemoglobin prior to surgery for both extracapsular and intracapsular fractures were 95.0 g/L (+/−SEM 2.2) and 108.5 g/L (+/−SEM 2.2) respectively. The difference was statistically significant (Students t-test p<0.05).The mean haemoglobin drop for male and female patients with extracapsular hip fractures were 15.0 g/l (range 0–40 g/l) and 19.3 g/l (range 0–49 g/l) respectively and the mean haemoglobin drop for male and female intracapsular fracture patients were 10.2 (range 0–59 g/l) and 10.5 g/l (range 0–41 g/l) respectively.Conclusions:Hip fracture patients have a large drop in haemoglobin that is likely to be associated with the initial trauma. Patients with extracapsular fractures demonstrate a greater haemoglobin loss than those with intracapsular fractures. This highlights the need for anaesthetic and orthopaedic staff to be vigilant to the risk of pre-operative anaemia in this cohort of frail patients.
Original languageEnglish
Pages (from-to)94
Number of pages1
JournalOrthopaedic Proceedings
Issue numberB
Publication statusPublished - 13 May 2011
EventEuropean Federation of National Associations of Orthopaedics and Traumatology - Madrid, Spain
Duration: 6 Jun 201110 Jun 2011


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  • The hidden blood loss after hip fracture

    Smith, G. H., Tsang, J., Molyneux, S. G. & White, T. O., 2011, In: Injury. 42, 2, p. 133-5 3 p.

    Research output: Contribution to journalArticlepeer-review

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