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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 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.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).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 IV Prognostic study.

Original publication

DOI

10.1016/j.aott.2015.11.001

Type

Journal article

Journal

Acta orthopaedica et traumatologica turcica

Publication Date

15/10/2016

Volume

50

Pages

507 - 513

Addresses

University of Oxford, Oxford, UK. Electronic address: navraj.nagra@ox.ac.uk.

Keywords

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