Clinical analysis of occult blood loss in treatment of proximal humeral fracture with shoulder hemiarthroplasty

Objective To determine the total bleeding,occult bleeding,and anticoagulant use in treatment of proximal humeral fracture combined with shoulder hemiarthroplasty in order to provide necessary data for the clinical treatment.Methods Sixty-one patients with proximal humeral fracture undergone shoulder hemiarthroplasty from July 2004 to July 2013 were retrospectively analyzed for preoperative and postoperative blood routine and intraoperative and postoperative blood loss.Results For all 61 patients,total blood loss was (981.3 ± 341.5)ml and hidden loss (525.7 ± 244.6)ml,with mean occult bleeding making up 54％.Anticoagulant was used in 20 patients,with occult blood loss of (616.0 ± 267.8) ml,accounting for 59％ of total bleeding [(1 051.3 ± 402.1) ml].Anticoagulant therapy was not initiated for 41 patients and their occult loss was (481.6 ± 222.7) ml,accounting for 51％ of total bleeding [(947.2 ± 307.4) ml].More occult bleeding was observed in patients with anticoagulant therapy than those without (P ＜ 0.05).Conclusions Occult loss predominates the total blood loss during shoulder hemiarthroplasty for patients with proximal humeral fracture,which is worthy of special attention.Moreover,further occult bleeding is observed in patients treated with anticoagulant therapy. Key words: Shoulder fractures;  Arthroplasty, replacement;  Blood loss, surgical;  Anticoagulant drug