Fractures of the femur and blood transfusions

Publication date: Available online 7 March 2018
Source:Injury
Author(s): Adam Wertheimer, Alexander Olaussen, Shanaka Perera, Susan Liew, Biswadev Mitra
BackgroundBlood 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 hours of admission.MethodsA 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 hours as well as operation details and patient outcomesResultsThere 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 hours of hospital admission.ConclusionVolume of blood transfused to patients with extra-capsular femoral fractures was low and usually in the post-operative period. Femoral shaft fractures, compared to femoral extremity fractures, were not more likely to receive blood transfusion within the first 48 hours of admission, and do not receive a higher volume of blood overall. In the setting of major trauma with haemorrhagic shock, alternate sources of bleeding should be sought.



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