Factors associated with perioperative blood loss and reduced postoperative hemoglobin levels in stable femoral pertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

Chirurgia Narządów Ruchu i Ortopedia Polska · Published 2026-06-29 · DOI 10.31139/chnriop.2026.91.2.2

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Authors (3)

Bartłomiej Juszczak, Elżbieta Broniatowska, Tomasz Pardała

Abstract

<p>Introduction. This analysis aimed to compare the impact of simple pertrochanteric fractures (PTFs), AO31-A1.2, and PTFs with lesser trochanter detachment, AO31-A1.3 on the postoperative level of hemoglobin.<br />Materials and methods. The study analyzed the data of 334 unilateral, stable PTFs classified as AO31-A1.2 (205 cases) and AO31-A1.3 (129 cases) treated with proximal femoral nail antirotation (PFNA). All patients were 65 years or older. The first postoperative hemoglobin level and the hemoglobin drop (difference between the first hemoglobin level on admission to the hospital and the first postoperative hemoglobin level) were chosen as the principal outcomes. Analyzed patients were not transfused between hemoglobin measurements. Multivariate linear regression was performed to identify perioperative risk factors for blood loss in patients undergoing surgery.<br />Results. Pertrochanteric fractures with the detachment of the lesser trochanter (AO31-A1.3) are associated with both a greater hemoglobin drop (p = 0.011) and a lower postoperative hemoglobin level (p = 0.078). The AO31-A1.3 fracture type is also associated with a greater risk of postoperative blood transfusion (p = 0.038). Females were associated with lower postoperative hemoglobin than men, irrespective of the type of fracture (9.31 g/dl vs 10.1 g/dl; p &lt; 0.0001). Multilinear regression analysis showed that age, gender, type of fracture, fracture gap displacement, preoperative hemoglobin level, and fracture gap angle significantly affect postoperative level of hemoglobin.&nbsp;<br />Conclusions. Despite being recognized as stable, pertrochanteric fractures with the detachment of the lesser trochanter (AO31-A1.3) are burdened with a greater risk of postoperative anemia and blood transfusion than simple PTF (AO31-A1.2) in the elderly. Fracture gap displacement and angle of fracture gap are useful predictors for a lower level of postoperative hemoglobin.<br />&nbsp;</p>

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Publication details

Year
2026

Citation

Juszczak, B., Broniatowska, E., Pardała, T. (2026). Factors associated with perioperative blood loss and reduced postoperative hemoglobin levels in stable femoral pertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). Chirurgia Narządów Ruchu i Ortopedia Polska. https://doi.org/10.31139/chnriop.2026.91.2.2

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