Comparison of plate and intramedullary nail fixation of extra-articular tibial fractures: A retrospective study exploring hidden blood loss

•Hidden blood loss exists in varying degrees in intramedullary nailing or plate fixation of extra-articular tibial fractures.•The amount of hidden blood loss of intramedullary nail fixation was significantly higher than that of plate fixation.•The risk of anemia and blood transfusion increased significantly after intramedullary nailing fixation.•The effect of hidden blood loss should be taken into account when the surgeon fixed the extra-articular tibial fractures. To explore the hidden blood loss (HBL) in treatment of extra-articular tibial fractures with plate and intramedullary nail fixation. We conducted a retrospective study including 209 consecutive patients treated by plate (Group LCP) or intramedullary nail fixation (Group IMN) for extra-articular tibial fractures between January 2015 to December 2017. Demographics, intraoperative data, perioperative laboratory values, transfusion rate, and early complications were collected and analyzed. Of 209 patients, 96 patients fixed with IMN and 113 fixed with LCP. The average HBL was 272.71 ± 57.88 ml in Group LCP and 507.66 ± 109.81 ml in Group IMN, and there was statistical difference in the HBL between two groups (p