Application of tranexamic acid during debridement for proximal-to-mid humeral chronic osteomyelitis: evaluation of blood management and infection-control safety

Background Adequate exposure and thorough removal of infected tissue are essential during debridement for chronic osteomyelitis. In proximal-to-mid humeral chronic osteomyelitis, complex anatomy, abundant musculature, and limited tourniquet feasibility may cause diffuse bleeding, impaired visualization, and prolonged surgery. Although tranexamic acid (TXA) is widely used for orthopaedic blood management, its infection-control safety in infected bone debridement remains unclear. We evaluated preoperative intravenous TXA in this setting. Methods This single-center retrospective cohort study included patients undergoing debridement for chronic osteomyelitis of the proximal or mid-humerus between January 2020 and March 2025. Patients were grouped by preoperative intravenous TXA use; the TXA group received 1.0 g approximately 30 min before surgery. Primary outcomes were second-stage frozen-section neutrophil count, unplanned repeat debridement, infection recurrence, and venous thromboembolic events. Secondary outcomes were operative time, estimated intraoperative blood loss, postoperative drainage volume, recorded perioperative blood loss, and transfusion. Results Eighty-two patients were included: 47 received TXA and 35 did not. Baseline characteristics were generally comparable. Operative time (139.2 ± 13.4 vs. 148.7 ± 11.8 min, P = 0.001), estimated intraoperative blood loss (289 ± 35 vs. 346 ± 49 mL, P < 0.001), postoperative drainage volume (160 ± 26 vs. 179 ± 23 mL, P < 0.001), and recorded perioperative blood loss (449 ± 47 vs. 525 ± 53 mL, P < 0.001) were lower in the TXA group. Transfusion rates did not differ significantly (8.5% vs. 14.3%, P = 0.486). Second-stage frozen-section neutrophil counts were similar (2.0 [1.0, 2.0] vs. 2.0 [1.0, 3.0], P = 0.106). Unplanned repeat debridement before the planned second-stage procedure occurred in 8.5% and 8.6% of patients ( P = 1.000), respectively, and infection recurrence during the observation period occurred in 8.5% and 11.4% ( P = 0.718), respectively. All recurrences occurred before the planned second-stage procedure; none occurred during at least 12 months of subsequent post-second-stage follow-up. Conclusions In selected patients without TXA contraindications, preoperative intravenous TXA was associated with lower perioperative blood-loss measures and shorter operative time, with no statistically detectable increase in infection-control adverse signals. No clinically diagnosed venous thromboembolic events were documented during follow-up.