Evaluating Postoperative Hidden Blood Loss in Proximal Femoral Nail Anti-Rotation Fixation: The Role of Greater Trochanter Fracture Comminution

BACKGROUND Intertrochanteric fractures can be managed using insertion of a proximal femoral nail anti-rotation (PFNA) intramedullary nail inserted into the femur. The helical blade used with the PFNA technique has the advantage of less bone removal and good biomechanical properties, but significant hidden blood loss (HBL) can occur. This study compared postoperative HBL in 219 elderly patients with intertrochanteric fractures using PFNA fixation, stratified by greater trochanter comminution status (comminuted vs non-comminuted). MATERIAL AND METHODS We retrospectively analyzed data on 219 elderly patients who underwent PFNA for intertrochanteric fractures between March 2019 and June 2024. The patients were divided into 2 groups: Group A (n=68) with comminuted fractures of the greater trochanter and Group B (n=151) with non-comminuted fractures. Demographic and clinical characteristics of patients were compared. Blood loss was calculated using established formulas. Intraoperative blood loss, postoperative HBL, postoperative complications, and length of hospital stay were statistically analyzed. RESULTS No significant differences were observed in demographic and clinical characteristics between the groups (P>0.05). However, Group A had significantly more intraoperative blood loss (70.0±24.1 ml vs 98.6±29.8 ml, P=0.000) and postoperative HBL (758.0±195.5 ml vs 1151.5±282.2 ml, P=0.000), and longer hospital stays (P=0.000), as well as higher rates of complications, including acute cerebral infarction, hemorrhagic shock, and heart failure (P values 0.015, 0.041, and 0.036, respectively). CONCLUSIONS Greater trochanter comminution is associated with significantly elevated HBL in intertrochanteric fractures treated with PFNA fixation. Orthopedic surgeons must recognize this risk factor in perioperative management.