Abstract:
Fractures of the femur due to increased road traffic
accidents are on the rise and lead among orthopedic trauma
conditions at Moi Teaching and Referral Hospital (MTRH). The
best treatment is open surgery with fixation and stabilization using
implants, mostly because fractures are either old or due to lack of
equipment for closed or percutaneous surgery, leading to blood
loss necessitating transfusion. MTRH experiences excessive blood
cross-match relative to actual transfusion, wasting reagents and
blood. There is a paucity of publications on factors associated with
blood loss and the transfusion pattern in open femur fracture
surgeries.The main objective was to determine factors affecting
blood loss and transfusion during open femoral fracture surgeries
at MTRH, Eldoret. A cross sectional study conducted at MTRH
on adult patients undergoing open femur fracture surgeries
between February 2022 and January 2023 on a sample of 172
patients using interviewer administered pretested structured
questionnaire. The results showed that the Age range: 18-92 years,
mean 47.3 ±20.3 years, majority male (71.5%). Blood loss: 45-
3960 mL, mean 1274.1 ±714 mL. Cross-matched all, but only
19.8% transfused (CTR: 6.7:1). BTR: 19.8%, mostly 2 units.
Transfusion reasons: visual estimation (58.8%), low hemoglobin
(41.2%). AO fracture 31: 51.7%. IM SIGN nail: 37.2%, PFNA:
33.1%. Spinal anesthesia: 82.6%, diathermy in all. Consultants led
83.7%, registrars 5.2%. Surgeries: >2 hours (41.9%), incision 15-
25 cm (69.8%).
This concludes that blood loss was high, with excessive
cross-matching and wastage of blood indicated by a high CTR,
while transfusion rates were low and primarily determined by
anaesthetists’ visual estimation. Factors contributing to blood loss
included timing of surgery, fracture complexity, and surgery
duration. From the study, prompt surgery to minimize blood loss,
anticipation of significant blood loss in complex cases, selective
cross-matching, transfusion only for patients with low
haemoglobin levels, and early identification and mitigation of
factors contributing to blood loss and transfusion.
