title: Traumax screw plate vs. Gamma nail. Blood loss in pertrochanteric fractures treated by minimally invasive osteosynthesis.
abstract: OBJECTIVE
  This study is aimed to determine whether the Traumax dynamic hip screw reduces perioperative blood loss and transfusion rate compared to the Gamma nail in the treatment of pertrochanteric fractures.
  
  
  METHODS
  A series of 331 patients were followed prospectively in a cohort study between February 2008 and October 2011 after a pertrochanteric fracture. Two types of fixation were used, 163 patients were treated with a Gamma nail and 168 patients with a minimally invasive screw plate Traumax. Perioperative blood loss, evaluated by the Mercuriali formula based on pre- and postoperative haemoglobin and transfusion rates were compared in order to assess risk factors.
  
  
  RESULTS
  Increased perioperative blood loss was significantly linked with patient-related parameters (age, anticoagulant and platelet aggregation inhibitor treatment). Type of osteosynthesis and type of fracture were also risk factors for blood loss and transfusion. The Traumax group had significantly lower blood loss (347 ml vs. 577 ml) and transfusion rate (33.9% vs. 63.8%) than the Gamma group. Involvement of the greater trochanter increased the risk of blood loss only in the Gamma group. Functional results and bone healing were comparable at six months follow-up.
  
  
  CONCLUSIONS
  Screw plate Traumax significantly reduces perioperative bleeding after pertrochanteric fractures. It avoids fracture gaps that tend to maintain bleeding. Given the morbidity and complications related to acute anaemia and blood transfusion, the surgical management of these elderly patients is aided by this choice of fixation.
authors.affiliation: Pierre Paul Riquet Hospital, Musculoskeletal Institute, CHU Toulouse, Toulouse - France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reina
authors.forename: Laurent
authors.initials: L
authors.lastname: Geiss
authors.forename: Régis
authors.initials: R
authors.lastname: Pailhé
authors.forename: Laurent
authors.initials: L
authors.lastname: Maubisson
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Laffosse
authors.forename: Philippe
authors.initials: P
authors.lastname: Chiron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome