Comparison of blood loss in dynamic hip screws and cephalomedullary nails for intertrochanteric fractures: a multivariate analysis based on fracture pattern and anticoagulant use

Background Anemia in intertrochanteric fractures (ITFs) is associated with higher morbidity and mortality and is an independent risk factor of functional mobility. Numerous studies have examined blood loss after different fixation systems. However, there is limited literature assessing the correlation of different variables that could influence blood loss in ITFs. The purpose of this study is to assess blood loss in ITFs stabilized using either dynamic hip screw (DHS) or cephalomedullary nail (CMN). Materials and methods Perioperative blood loss was evaluated in 621 consecutive patients treated for ITFs with DHS and CMN between March 2011 and January 2021. Estimated blood loss (EBL) was calculated using the modified Lisander formula. Multivariable linear regression was performed to assess associations between implant type and EBL, adjusting for age, sex, BMI, ASA score, fracture pattern (AO/OTA type 31A1 and 31A2), anticoagulant use, and time to surgery (early: <48 h vs. late: ≥48 h). Results DHS was associated with significantly lower EBL (613.7 mL vs. 728.7 mL; p < 0.001). In multivariable analysis, CMN was independently associated with higher blood loss (β = 119.4 mL; 95% CI 42.2–196.7; p = 0.003). Use of anticoagulants, male sex, and higher fracture severity (A2 vs. A1) were also associated with increased blood loss. DHS showed a trend toward lower transfusion volume (CMN vs. DHS, β = 65.3 mL; 95% CI -46.8–102.0; p = 0.138), though implant type was not a significant predictor of transfusion requirement (CMN vs. DHS, OR = 1.040; p = 0.212). Surprisingly, anticoagulant use was associated with slightly lower EBL (β= -109.5 mL; 95% CI -186.7– -32.3; p = 0.006). Conclusions DHS was associated with lower perioperative blood loss and reduced transfused volume compared to CMN in AO/OTA type 31A1 and 31A2 ITFs. These findings support DHS as a potential option for patients at higher risk of anemia or transfusion-related complications.