Proximal humeral fractures are common in upper limb fractures with the third highest incidence after hip fractures and distal radius fractures , accounting for 4% to 5% of total body fractures. The aging society has witnessed an increasing trend of the morbidity and mortality of proximal humeral fractures among the elderly group. The mortality is known to increase with perioperative anemia. Perioperative blood loss is a significant yet easily neglected factor for upper limb fracture patients. Cases of patients with proximal humeral fractures undergone procedures of PHILOS locking plate and Multiloc intramedullary nail were retrospectively analyzed. It is hoped that our study will demonstrate the importance of consideration of patients’ revealed and hidden blood loss as to improve the prognosis.

To analyze the revealed and hidden blood loss in elderly proximal humeral fractures treated with PHILOS locking plate and Multiloc intramedullary nail.

The clinical data of 45 elderly patients with proximal humeral fractures treated with PHILOS locking plate and 37 elderly patients treated with Multiloc intramedullary nail were retrospectively analyzed from January 2016 to December 2019, respectively. The operation time, perioperative revealed blood loss and perioperative hidden blood loss were compared, and the perioperative blood loss was evaluated and analyzed.

The mean operation time of the PHILOS locking plate treatment group was (141.78±36.18) min, the total blood loss was 674.68 (592.87, 979.65) ml, and the perioperative revealed blood loss was 320.00 (220.00, 430.00) ml. The mean operation time of Multiloc intramedullary nail treatment was (102.70±22.10) min, the total blood loss was 589.23 (430.80, 714.82) ml, and the perioperative revealed blood loss was 100.00 (100.00, 125.00) ml. The difference between two groups was statistically significant (P<0.05) . The perioperative hidden blood loss in the two groups was 383.55 (253.17, 575.48) ml and 460.98 (309.87, 610.25) ml, which was not statistically significant (P>0.05) , accounting for 56.85% and 78.23% of the total blood loss, respectively.

Compared with PHILOS locking plate, the average operation time of Multiloc intramedullary nail group is short, and both the total blood loss and the revealed blood loss are less. There was no significant difference in the amount of hidden blood loss between the two methods of internal fixation. The proportion of hidden blood loss in total blood loss in both two procedures was large, which should be paid more attention to in clinical practice. Thus, clinical attention should be paid to the positive intervention to improve the prognosis of patients.