To analyze the total blood loss, obvious blood loss and hidden blood loss during intramedullary nailing of femoral shaft fractures.

A retrospective study was conducted of the clinical data of 41 patients with femoral shaft fracture who had been treated with intramedullary nailing from July 2010 to May 2016. They were 30 men and 11 women, from 19 to 85 years of age (average, 55.7 years). Involved were 19 sides and 22 right ones. By AO classification, type 32-A was in 21 cases, type 32-B in 13 ones, and type 32-C in 7 ones. The intervals from injury to surgery averaged 3.7 days (range, from 12 hours to 8 days). They were divided into 2 groups according to age. In the young group of <65 years, there were 23 cases; in the elderly group of ≥65 years, there were 18 ones. Comparisons were made between the 2 groups regarding preoperative and postoperative blood routine, intraoperative and postoperative blood loss.

The total blood loss of the 41 patients averaged 2,076.8 mL and the hidden blood loss 1,796.5 mL, yielding a proportion of average hidden blood loss of 86.5%. In the young group, the total blood loss averaged 1,917.5±548.1 mL and the hidden blood loss 1,641.6±468.1 mL. In the elderly group, the total blood loss averaged 2,280.3±436.9 mL and the hidden blood loss 1,994.5±408.0 mL. The differences between the 2 groups were statistically significant(P<0.05). However, there was no significant difference between the 2 groups in the obvious blood loss (P>0.05). The proportion of average hidden blood loss was 85.6% in the young group and 87.5% in the elderly group.

Hidden blood loss may account for the overwhelming majority proportion of the perioperative total blood loss in patients with femoral shaft fracture undergoing intramedullary nailing. The elderly patients may be prone to more hidden blood loss.

Femoral fractures; Fracture fixation, intramedullary; Bone nails; Blood loss, surgical