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OBJECTIVES: The aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture. PATIENTS AND METHODS: Patients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored perioperatively. RESULTS: Analysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p < 0.001), with significant reductions from D0 to day-1 and day-1 to day-2 (p < 0.001). At each post-operative time point, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p = 0.046). CONCLUSION: The decrease in hemoglobin in the first 24-h post-operative period (D0 to day-1) is an underestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to be transfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring. LEVEL OF EVIDENCE: Level IV Prognostic study.

Original publication

DOI

10.1016/j.aott.2015.11.001

Type

Journal article

Journal

Acta orthop traumatol turc

Publication Date

10/2016

Volume

50

Pages

507 - 513

Keywords

Fracture, Hemoglobin, Neck of femur, Postoperative, Aged, Aged, 80 and over, Bone Screws, Female, Femoral Neck Fractures, Femur, Fracture Fixation, Internal, Hemiarthroplasty, Hemoglobins, Humans, Male, Middle Aged, Postoperative Period, Prognosis, Prospective Studies, Time Factors