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Injury. 2018 Apr;49(4):846-851. doi: 10.1016/j.injury.2018.03.007. Epub 2018 Mar 7.

Fractures of the femur and blood transfusions.

Author information

1
Department of Orthopaedic Surgery, The Alfred Hospital, Australia. Electronic address: Adam.Wertheimer@nh.org.au.
2
Emergency & Trauma Centre, The Alfred Hospital, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; National Trauma Research Institute, The Alfred Hospital, Australia.
3
Department of Orthopaedic Surgery, The Alfred Hospital, Australia.

Abstract

BACKGROUND:

Blood loss estimation after trauma (i.e. physical injury) and early identification of potential sources of bleeding are important for planning of investigation and management of trauma. Long bone fractures have been reported to be associated with substantial volumes of blood loss requiring blood transfusion. The aim of this study was to assess rates and amounts of blood transfusion in the setting of isolated extra capsular femur fractures and to determine variables associated with the need for transfusion within the first 48 h of admission.

METHODS:

A retrospective cohort study was conducted of patients in The Alfred Trauma Registry with isolated extra capsular femur fractures over a 7-year period. We compared patients with a femoral shaft fracture (FSF) to patients with either distal femur or proximal femur fractures (i.e. extremity fracture). We collected data potentially associated with blood transfusion within 48 h as well as operation details and patient outcomes.

RESULTS:

There were 293 patients included, of which 121 had FSF and 172 extremity fracture. 105 (36%) patients received a blood transfusion during their admission. Admission haemoglobin (AOR 0.92; 95%CI 0.89-0.94, p < 0.01) was the only independently associated variable with blood transfusion within the first 48 h of hospital admission.

CONCLUSION:

Volume of blood transfused to patients with extra-capsular femoral fractures was low and usually in the post-operative period. FSF, compared to femoral extremity fractures, were not more likely to receive blood transfusion within the first 48 h of admission, and did not receive a higher volume of blood overall. In the setting of major trauma with haemorrhagic shock, alternate sources of bleeding should be sought.

KEYWORDS:

Blood transfusion; Femoral fractures; Femur; Hemorrhage; Hemorrhagic; Shock

PMID:
29566986
DOI:
10.1016/j.injury.2018.03.007
[Indexed for MEDLINE]

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