dc.contributor.author | Kirii, James Mwaniki | |
dc.date.accessioned | 2020-05-12T07:22:38Z | |
dc.date.available | 2020-05-12T07:22:38Z | |
dc.date.issued | 2019 | |
dc.identifier.uri | http://erepository.uonbi.ac.ke/handle/11295/109419 | |
dc.description.abstract | Background: Diaphyseal femoral fractures are some of the commonest injuries treated in
Kenyatta National Hospital. The sharp increase in these patients is due to rise of motorizing
mode of transport, making it a public health concern in our country. The intramedullary nailing
system for fixation of these fractures commonly available in KNH is the one utilizing distal
locking jig making it an open method. Lack of equipment like image intensifier, traction table
and long duration of stay before surgery favors open intramedullary nailing. Determining the
level of expected blood loss, predicts the need for blood transfusion during surgery. Factors that
affect blood loss during open intramedullary nailing can greatly influence pattern of blood loss
and transfusion needs. There is paucity of data on the quantity of blood loss and transfusion
pattern in open intramedullary nailing of femoral fractures.
Objectives: To determine blood loss and transfusion pattern in patients undergoing open
reduction and intramedullary nailing of diaphyseal femoral fractures.
Study design: Prospective observational cross-sectional study
Setting: KNH orthopaedic wards and theatres
Methodology: Consecutive sampling was used to enroll eligible patients with a closed
diaphyseal femoral fractures undergoing open interlocking nailing procedure one day before
operation. The patients were identified after decision to operate was made and one day before the
day of surgery. Written consent was sought from the patient. Patients’ biodata was acquired and
recorded. The pattern of the fracture was observed and recorded. Time between admission and
surgery was also noted. The blood sample was obtained and taken to the laboratory for
hemoglobin level test before surgery, intraoperative parameters such as mode of anesthesia,
diathermy use, average intra-operative blood pressure, duration of surgery, length of incision and
units of blood transfused were noted. Repeat HB level test was done 72 hours after surgery. The
collected data was analyzed using SPSS v.20 and Microsoft excels, and presented in the form of
percentages, means and their 95% confidence intervals.
x
Timeline: The study was carried out between February 2017 and June 2018
Results: The study involved seventy subjects comprising of males (84%) and females (16%).
Average (mean) age of the subjects was 32 years. The mean blood loss estimated was 3.3g/dl
which is equivalent to 1485ml. Of the total patients 94% had blood cross-match requested but
only 35% received blood transfusion. For those who received transfusion, only one unit was
given per patient. The main reason for transfusion was anesthetist assessment of intraoperative
bleeding at 69.2%. The factors than mainly influenced blood loss was the complexity of fracture
and duration between injury and surgery. All the patients were operated under spinal anaethesia
and median length of operation was 120 minutes. Diathermy was used in 75% of the cases and
most surgeries were done by registrars at 84%. The ratio of blood cross-matched to that which
was transfused was 4.5:1.
Conclusion and recommendation: Fractures operated early have significant low blood loss.
Lack of blood for transfusion should not be a limiting factor for operating patients with a HB
above 13.5g/dl. There is unnecessary cross-matching for patient undergoing open ILN. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
dc.title | Blood Loss And Transfusion Patterns During Open Intramedullary Nailing Of Diaphyseal Femoral Fractures In Kenyatta National Hospital | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |