Skip to main content
Download PDF
  • Research article
  • Open access
  • Published:

The effects of prophylactic administration of tranexamic acid on the operative time and the amount of blood transfused during open fixation of pelvis and acetabulum fractures

Journal of Orthopaedic Surgery and Research volume 19, Article number: 606 (2024) Cite this article

Abstract

Background

Orthopedic surgeons face challenges regarding perioperative bleeding during the operations of pelvic and acetabular fracture cases. Although the recently popular tranexamic acid (TXA) has proven to be a useful tool, this study primarily aimed to conduct a retrospective comparative analysis of the results of the prophylactic administration of tranexamic acid during open fixation of pelvis and acetabulum fractures, especially regarding operative time and the amount of blood transfused; and in addition, share the results related to other findings including the management of the erythrocyte suspension use and overall cost as secondary aims and thus providing a comprehensive point of view.

Methods

The files of patients with pelvis or acetabulum fractures admitted to the Emergency Clinic of the Adana City Training and Research Hospital between January 1, 2020, and December 31, 2023, were analyzed retrospectively. The inclusion criteria were as follows: patients aged 18 years or older who had undergone open reduction for pelvis or acetabulum fractures.

Results

There were 78 files identified for analysis. Among the fractures, 27 were located at the pelvis (34.61%) and 51 at the acetabulum (65.38%). The pelvic fracture cases’ age and preoperative hemoglobulin levels were significantly lower (p = 0.019 and p = 0.006, respectively). When all cases were dichotomized into two groups, ones requiring ICU monitoring and the remaining, there were statistically significant differences in terms of the preoperative hemoglobin levels (p = 0.0446), intraoperative bleeding (p = 0.0134), units of erythrocyte suspension used (p = 0.0066), drain output (p = 0.0301), hospitalization duration (p = 0.0008), and the overall cost (p = 0.0002). The comparison regarding TXA use showed that the use of blood products was significantly higher in the pelvic fractures not treated with TXA (6.44 ± 4.42 units, p = 0.0029). The duration of surgery was shorter for pelvic fractures treated with TXA (98.33 ± 21.76 min, p = 0.047).

Conclusion

Among the variables, the amount of intraoperative bleeding emerged as the most correlated element, which strongly suggests that in managing open reduction internal fixation surgeries performed for pelvis and acetabulum fractures, intraoperative bleeding should be considered as the crucial factor. Therefore, the administration of TXA, by effectively reducing the amount of intraoperative bleeding, should be considered as an essential tool for orthopedic surgeons.

Introduction

Fractures of the pelvic ring and acetabulum account for less than 3% of all skeletal fractures. The fractures are usually caused by high-energy trauma, and the wide range of treatments depends on the type of fracture and additional conditions [1].

Pelvis and acetabulum fractures, which account for 2–5% of fractures requiring hospitalization, result in prolonged hospitalization and immobilization and consequently increased work loss and treatment costs [2,3,4]. In addition, the mortality rate ranges from 5 to 50%, making pelvic ring and acetabular fractures one of the leading causes of mortality among all fracture injuries [5]. In the early post-injury period, approximately 50 to 60% of the mortality was related to bleeding [6].

A significant blood loss occurs during and after surgical treatment. Some studies reported a mean total blood loss of up to 2818 mL [7, 8]. Therefore, early transfusion of blood products can be life-saving for patients. However, transfusion of erythrocyte suspensions (ES) may cause side effects such as hemolytic reactions, infection, and multiple organ failure and may lead to an increase in the number of hospitalization days, intensive care unit admissions, costs, and mortality [9].

In the surgical treatment of the fractures of the pelvic region, in terms of minimizing intra-operative blood loss, tranexamic acid (TXA) is an increasingly popular synthetic lysine derivative that competitively inhibits the conversion of plasminogen to plasmin. The inhibition prevents fibrin degradation and dissolution of formed clots [10]. Intravenous or local administration of TXA can be performed during surgery, but there is no consensus on the optimal dose and route of administration [11]. Yet, studies comparing the use of TXA in both pelvis and acetabulum fracture surgery, particularly in terms of incision method, fracture subtypes, complications, and costs, are scarce.

Although the recently popular tranexamic acid (TXA) has proven to be a useful tool, this study primarily aimed to conduct a retrospective comparative analysis of the results of the prophylactic administration of tranexamic acid during open fixation of pelvis and acetabulum fractures, especially regarding operative time and the amount of blood transfused and in addition, share the results related to other findings including the management of the erythrocyte suspension use and overall cost as secondary aims and thus providing a comprehensive point of view.

Materials and methods

Ethical approval

was obtained from the Adana City Training and Research Hospital Clinical Research Ethics Committee on November 17, 2022, with decision number 2252. The patients’ rights rules of the Declaration of Helsinki were followed.

Study design and data collection

The files of patients with fractures located in the pelvis or the acetabulum admitted to the Emergency Clinic of the Adana City Training and Research Hospital between January 1, 2020, and December 31, 2023, were analyzed retrospectively. The inclusion criteria were as follows: aged 18 years or older, having undergone open reduction for pelvis or acetabulum fractures, using the Kocher Langenbeck (posterior) approach [12], modified stoppa (anterior) approach [13], and combined approach incision methods, and having used tranexamic acid intraoperatively.

The files with fractures on both pelvis and acetabulum, ones with coagulation disorders, on medication for or having a condition related to coagulation, including Hemophilia, Von Willebrand disease, clotting factor deficiencies, and hypercoagulable states, and the files with incomplete data were excluded from the analysis. In addition, files of earthquake survivors were excluded due to the possible additional conditions that could not be identified at the time of the admission, which might have altered the course of the outcome. The study flowchart diagram is presented in Fig. 1. The cut-off time for defining early surgery was set at 48 h. Therefore, cases operated before the 48th hour following the injury were indicated as early.

Fig. 1
figure 1

The flowchart diagram of the study

Full size image

The data collected from the files included age, gender, type of trauma, hemoglobin levels before and after surgery, amount of intraoperative bleeding, drain output, number of erythrocyte suspension (ES) packs prepared and used, perioperative (TXA) use, duration of surgery, complications, hospitalization duration, and the overall hospitalization cost.

Initially, the cases were dichotomized into two groups based on the localization of the fractures: pelvis and acetabulum. The fractures were classified using Young Burgess’s system for pelvis and Judet Letourne’s system for acetabulum fractures [14, 15]. However, we have classified the iliac crest fractures separately because of the limited use of Young and Burgess classification and the need for further development [16]. The records showed that all patients received venous thromboembolism prophylaxis from the day of hospitalization to prevent thromboembolic complications, including deep vein thrombosis and pulmonary embolism.

Cefazolin sodium 2 gr was administered intravenously 30 min before the surgical procedure. The same experienced staff performed the operations for all cases. Following anesthesia, patients were placed on a radiolucent table in a supine position if an anterior incision was to be made; in posterior incision cases, a lateral decubitus position was preferred. The surgical field was cleaned with a chlorhexidine gluconate brush, stained with povidone-iodine, and covered. An antimicrobial adhesive dressing was applied to the surgical field to reduce the possibility of surgical infection.

The administration of 1 g TXA (Transamine®, 250 mg/2.5 mL IV Injectable Solution Teva Pharmaceuticals, Türkiye) in 100 mL of saline solution (0.9%) was performed 30 min before the surgery as an intravenous infusion in 15 min.

Postoperative blood counts were analyzed, and blood transfusion was performed according to the clinical practice guidelines of the American Association of Blood Banks in patients with hemoglobin values less than 8 g/dL. Drains were removed, and passive hip exercises were started on the first postoperative day.

Statistical analysis

The statistical analyses were performed using SPSS 23.0 for Windows. Descriptive statistics were reported as numbers, percentages, mean, and standard deviation. The numbers and percentages were rounded to the nearest value. Kolmogorov-Smirnov and Shapiro-Wilk tests were performed for categorical variables and were compared using ANOVA or Kruskall-Wallis tests according to the conformity to normal distribution. Parameters with significance in numerical variables were compared using unpaired t-tests or Mann-Whitney U tests according to the conformity for normal distribution. The correlation between variables was determined using Spearman’s test, with coefficient “r” scores indicating different levels of correlation. The results were evaluated at a 95% confidence interval, and p < 0.05 was considered significant.

Results

After all exclusion criteria were met, there were 78 files identified for analysis. Among the fractures, 27 were located at the pelvis (34.61%) and 51 at the acetabulum (65.38%). The mean age was 44.29 ± 16.27 (18–79 years), and there were 65 males (83.33%).

Three main events caused the patients’ fractures: traffic accidents (n = 40, 51.28%), falls from height (n = 37, 47,44%), and gunshot wounds (n = 1, 1.28%). There were 39 (50%) cases operated within the first 48 h (15 pelvis and 24 acetabulum fractures).

In the analysis of the intraoperative bleeding amount values (ml) according to age divided by deciles, the values were 604.76 ± 232.32, 391.67 ± 247.02, 454.17 ± 98.76, 720 ± 314.99, and 613.71 ± 255.71 in the age groups below 30 years, 30–40 years, 40–50 years, 50–60 years, and over 60 years, respectively. The amount of intraoperative bleeding in the 50–60 age group was statistically significantly higher (p < 0.05). A similar difference was found in terms of overall costs. The average overall cost was significantly higher in the 50–60 age group (p < 0.05).

The pelvic fracture cases’ age and preoperative hemoglobulin levels were significantly lower (p = 0.019 and p = 0.006, respectively) (Table 1).

Table 1 Comparison of the pelvis and acetabulum fracture cases in terms of average baseline data
Full size table

The number of patients requiring ICU monitoring was 26 (33.33%). When all cases were dichotomized into two groups, ones requiring ICU monitoring and the remaining, there were statistically significant differences in terms of the preoperative hemoglobin levels (p = 0.0446), intraoperative bleeding (p = 0.0134), units of erythrocyte suspension used (p = 0.0066), drain output (p = 0.0301), hospitalization duration (p = 0.0008), and the overall cost (p = 0.0002).

The analysis based on the subtypes of acetabulum fracture cases revealed that the units of ES and the duration of surgery significantly differed among the subtypes of the fractures (p = 0.0208 and p < 0.0001, respectively) (Supplemental Table 1a). On the other hand, no significant difference was found according to the subtypes of pelvic fracture cases (Supplemental Table 1b).

A total of 57 patients received TXA. The comparison in terms of TXA use showed that the use of erythrocyte suspension was significantly higher in the pelvic fractures not treated with TXA (6.44 ± 4.42 units, p = 0.0029) (Table 2). Furthermore, the duration of surgery was shorter for pelvic fractures treated with TXA (98.33 ± 21.76 min, p = 0.047).

Table 2 The comparison of pelvis and acetabulum fractures in terms of the tranexamic acid (TXA) administration
Full size table

The comparison of the incision method revealed no significant differences between the parameters. The complication rate was considerably low (n = 10, 12.82%). There were six wound site infections (8.97%), and four nerve sequelae cases (5.13%). The analysis showed significantly less drain output volume in patients without complications (p = 0.0247).

The correlation analysis revealed significant relations (Table 3). The average days before surgery and the hospitalization duration were positively associated (r = 0.348, p = 0.0018). The duration of surgery demonstrated a similar link with the amount of intraoperative bleeding, drain output, hospitalization duration, and overall costs (r = 0.560, p < 0.0001; r = 0.354, p = 0.0015; r = 0.288, p = 0.0105; r = 0.374, p = 0.0007, respectively). Besides, the units of ES used were positively related to intraoperative bleeding, hospitalization duration, and overall costs (r = 0.865, p < 0.0001; r = 0.559, p < 0.0001; r = 0.560, p < 0.0001, respectively). The hospitalization duration was also linearly correlated to overall cost (r = 0.409, p = 0.0002). Finally, the duration of surgery and postoperative hemoglobin levels (r=-0.383, p = 0.0005) and preoperative hemoglobin levels and overall costs (r=-0.318, p = 0.0046) were negatively correlated.

Table 3 The correlation analysis for the variables
Full size table

Discussion

The study results indicate that regardless of the method of incision and the need for ICU monitoring, the open reduction surgery of the pelvis and acetabulum fractures requires meticulous planning regarding perioperative bleeding management. Each subtype of the fractures that occurred in both regions demonstrated different outcomes. The results were influenced by various factors beginning from the preoperative phase, such as the patient’s hemoglobin level and the days before the surgery, to the final assessment, including the unused ES cost.

Firstly, the number of open reduction and internal fixation surgeries for acetabular fractures (n = 51) was much higher than that for pelvic fractures (n = 27). The rates of dominance of surgeries for acetabular fractures over pelvic fractures may vary, but similar results were observed in other studies [17, 18]. The causes of the fractures were traffic accidents and falls from heights parallel to the literature [9, 19]. The male-female ratio, varying greatly among the studies, was dominated by males, in parallel to the literature [20]. The age analysis showed that the average age of the cases with pelvic fractures was significantly lower. Comparably, in a study conducted on 11,149 cases, Giannoudis et al. demonstrated that pelvic fractures peaked in the age group below 30 years and between 40 and 60 years [21].

The impact of the timing of surgery on the management of patients with pelvis and acetabulum fractures is still controversial, with differing opinions in the literature. Although there are studies indicating that definitive fixation should be performed after the fourth day of injury when the patient’s physiologic status is favorable for surgery, the definition of early or late fixation in pelvis fractures in the literature varies from 8 h to 2 weeks [18, 22, 23]. We identified the early period in pelvis and acetabulum surgery as the 48th hour, considered the latest time for the least possible bleeding and blood transfusion requirement. Similarly, Parry et al. found that patients with pelvic fractures operated on earlier than the first 48th hour had significantly less bleeding and need for blood transfusion than patients operated on later [24].

The analysis regarding the method of incision indicated there were no differences in the variables. In parallel, in a study on complicated acetabular fractures, the comparison of anterior and posterior methods showed no significant differences regarding the duration of surgery, intraoperative bleeding, and hospitalization duration [25].

Another finding in our study was that the preoperative hemoglobin levels in cases of pelvic fractures were significantly lower. The size of the bone exposed to the trauma and the fracture displaced by the force are shown to be major factors in the prediction of blood loss, adding that various subtypes of pelvic fractures are prone to more bleeding, including vertical shear and bilateral pubic rami (butterfly) fractures. In parallel, Tibbs et al. stated that pelvic ring fracture cases had lower Hb levels at admission, higher transfusion needs, and increased hospital length of stay in the study conducted on acetabular and isolated pelvic ring fractures [26,27,28].

The comparison of the groups in terms of TXA administration results revealed a slight difference in the duration of surgery. An interesting finding was highlighted by Kenmegne et al., indicating that the average duration of surgery in the group treated using TXA was obviously but not statistically lower [29]. Also, Cohen-Levy et al. stated that particularly in pelvic and acetabulum fracture cases in whom the venous thromboembolism prophylaxis was discontinued, the administration of TXA during surgery was reliable and useful in decreasing the duration of the operation [30]. The significant difference in the amount of ES used was supported by numerous researches suggesting that the use of TXA cuts down blood loss and decreases the need for transfusions [31, 32].

The rate of complications in our study was relatively low. However, most of the studies reported in the literature were conducted with small sample sizes and, like ours, have limited information on long-term outcomes of complications [33, 34]. Thus, the level of epidemiologic data on pelvis and acetabulum fractures appears to be low, making it difficult to make a reliable comparison.

The correlation analysis demonstrated significant positive links between intraoperative bleeding, the units of ES used, duration of surgery, drain output, and hospitalization duration. The strong correlations observed should prompt enhanced awareness that the quantity of blood lost during surgery is associated with each stage of patient care.

In our study, the hospitalization duration and the overall cost were significantly reduced in patients who underwent early surgery, but there was no significant difference between the pelvic and acetabular fracture groups in terms of bleeding and blood transfusion.

The overall cost results showed no difference between the pelvis and acetabulum fracture groups (1455.10 USD vs. 1447.57 USD). Furthermore, studies on the total cost of pelvic trauma showed figures up to 10–20 times higher than our results [35, 36], . Even when the results are calculated based on the national income per capita, the difference indicates that pelvic fracture surgery is performed at lower costs in our country.

Limitations

The retrospective design, having conducted in a single center and the sample size were the most important limitations of the study. Furthermore, our transfusion threshold was set at 8 mg/dl hemoglobin. Because the size of the cancellous bone exposed to the trauma force and the displacement characteristics of the fracture are important factors in the amount of bleeding and can vary even within identical anatomic fracture sites, the results of the study would have been significantly different if a more restrictive transfusion threshold had been used.

Conclusions

Pelvis and acetabulum fractures are injuries that require a significant amount of blood transfusion regardless of the anterior or posterior method of approach. Our study revealed that, among the variables, the amount of intraoperative bleeding emerged as the most correlated element, which strongly suggests that in the management of open reduction internal fixation surgeries performed for pelvic and acetabular fracture cases, intraoperative bleeding should be considered as the crucial factor. Therefore, the administration of TXA, by effectively reducing the amount of intraoperative bleeding, should be considered as an essential tool for orthopedic surgeons.

Data availability

The data supporting this study’s findings are available from the corresponding authors, ES and MYG, upon request.

References

  1. Pereira GJC, Damasceno ER, Dinhane DI, Bueno FM, Leite JBR, Ancheschi BDC. Epidemiology of pelvic ring fractures and injuries. Revista Brasileira De Ortop (English Edition). 2017;52:260–9.

    Article  Google Scholar 

  2. Pizanis A, Pohlemann T, Burkhardt M, Aghayev E, Holstein JH. Emergency stabilization of the pelvic ring: clinical comparison between three different techniques. Injury. 2013;44:1760–4.

    Article  CAS  PubMed  Google Scholar 

  3. Balogh Z, King KL, Mackay P, McDougall D, Mackenzie S, Evans JA, et al. The Epidemiology of Pelvic Ring fractures: a Population-based study. J Trauma: Injury Infect Crit Care. 2007;63:1066–73.

    Google Scholar 

  4. Kugelman DN, Fisher N, Konda SR, Egol KA. Loss of ambulatory independence following low-Energy Pelvic Ring fractures. Geriatr Orthop Surg Rehabil. 2019;10:2151459319878101.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Paydar S, Chaabi M, Akhavan M, Ghahramani Z, Dehghankhalili M. Outcome determinants of patients with traumatic pelvic fractures: a Cohort Study in a Level I Trauma Center in Southern Iran. Malays Orthop J. 2017;11:23–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23:98.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Raobaikady R, Redman J, Ball JaS, Maloney G, Grounds RM. Use of activated recombinant coagulation factor VII in patients undergoing reconstruction surgery for traumatic fracture of pelvis or pelvis and acetabulum: a double-blind, randomized, placebo-controlled trial. Br J Anaesth. 2005;94:586–91.

    Article  CAS  PubMed  Google Scholar 

  8. Odak S, Raza A, Shah N, Clayson A. Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery. Ann R Coll Surg Engl. 2013;95:357–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Charles A, Shaikh AA, Walters M, Huehl S, Pomerantz R. Blood transfusion is an independent predictor of mortality after blunt trauma. Am Surg. 2007;73:1–5.

    Article  PubMed  Google Scholar 

  10. McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72:585–617.

    Article  CAS  PubMed  Google Scholar 

  11. Ockerman A, Vanassche T, Garip M, Vandenbriele C, Engelen MM, Martens J, et al. Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review. Thromb J. 2021;19:54.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gänsslen A, Grechenig S, Nerlich M, Müller M. Standard approaches to the Acetabulum Part 1: Kocher-Langenbeck Approach. Acta Chir Orthop Traumatol Cech. 2016;83:141–6.

    Article  PubMed  Google Scholar 

  13. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;:112–23.

  14. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160:445–51.

    Article  CAS  PubMed  Google Scholar 

  15. Judet R, Judet J, Letournel E, FRACTURES OF THE ACETABULUM:. CLASSIFICATION AND SURGICAL APPROACHES FOR OPEN REDUCTION. PRELIMINARY REPORT. J Bone Joint Surg Am. 1964;46:1615–46.

    Article  CAS  PubMed  Google Scholar 

  16. Osterhoff G, Scheyerer MJ, Fritz Y, Bouaicha S, Wanner GA, Simmen H-P, et al. Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess. Injury. 2014;45:742–7.

    Article  PubMed  Google Scholar 

  17. Lundin N, Huttunen TT, Berg HE, Marcano A, Felländer-Tsai L, Enocson A. Increasing incidence of pelvic and acetabular fractures. A nationwide study of 87,308 fractures over a 16-year period in Sweden. Injury. 2021;52:1410–7.

    Article  PubMed  Google Scholar 

  18. Enocson A, Lundin N. Early versus late surgical treatment of pelvic and acetabular fractures a five-year follow-up of 419 patients. BMC Musculoskelet Disord. 2023;24:848.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Taş T, Tezeren SG, Öztemur Z, Güneyli V, Çilli K. Effectiveness of conservative treatment on adult pelvis fracture. Basic Clin Sci. 2014;2:108.

    Article  Google Scholar 

  20. Audretsch C, Trulson A, Höch A, Herath SC, Histing T, Küper MA. Evaluation of decision-making in the treatment of acetabular fractures. EFORT Open Rev. 2022;7:84–94.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Giannoudis PV, Grotz MRW, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007;63:875–83.

    PubMed  Google Scholar 

  22. Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–84.

    PubMed  Google Scholar 

  23. Katsoulis E, Giannoudis PV. Impact of timing of pelvic fixation on functional outcome. Injury. 2006;37:1133–42.

    Article  PubMed  Google Scholar 

  24. Parry JA, Nino S, Khosravani N, Weber L, Haidukewych GJ, Koval KJ, et al. Early Operative Treatment of Acetabular Fractures does not increase blood loss: a retrospective review. J Orthop Trauma. 2020;34:244–7.

    Article  PubMed  Google Scholar 

  25. Yao Y, Xue C, Sun Y, Zhan J, Jing J. [Comparison of effectiveness between two combined anterior and posterior approaches for complicated acetabular fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018;32:1512–7.

    PubMed  Google Scholar 

  26. Tibbs BM, Kopar P, Dente CJ, Rozycki GS, Feliciano DV. Acetabular and isolated pelvic ring fractures: a comparison of initial assessment and outcome. Am Surg. 2008;74:538–41. discussion 541.

    Article  PubMed  Google Scholar 

  27. Eastridge BJ, Starr A, Minei JP, O’Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–50. discussion 450–451.

    Article  PubMed  Google Scholar 

  28. Spitler CA, Row ER, Gardner WE, Swafford RE, Hankins MJ, Nowotarski PJ, et al. Tranexamic Acid Use in Open reduction and internal fixation of fractures of the Pelvis, Acetabulum, and proximal femur: a Randomized Controlled Trial. J Orthop Trauma. 2019;33:371–6.

    Article  PubMed  Google Scholar 

  29. Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Banneyake EL, et al. A prophylactic TXA administration effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures. Sci Rep. 2023;13:12570.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Cohen-Levy WB, Rush AJ, Goldstein JP, Sheu JI, Hernandez-Irizarry RC, Quinnan SM. Tranexamic acid with a pre-operative suspension of anticoagulation decreases operative time and blood transfusion in the treatment of pelvic and acetabulum fractures. Int Orthop. 2020;44:1815–22.

    Article  PubMed  Google Scholar 

  31. Sharaby MMF, El-Deeb YM. Is intravenous tranexamic acid effective in reduction of blood loss during pelvic and acetabular surgery? Int Orthop. 2022;46:1721–9.

    Article  PubMed  Google Scholar 

  32. Tekin SB, Demir IH, Bozgeyik B, Mert A. How does tranexamic acid affect blood transfusion and bleeding amount in pelvis-acetabulum fractures treated with open reduction and internal fixation? Ulus Travma Acil Cerrahi Derg. 2022;28:1323–7.

    PubMed  PubMed Central  Google Scholar 

  33. Giannoudis PV, Grotz MRW, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br. 2005;87:2–9.

    Article  CAS  PubMed  Google Scholar 

  34. Giustra F, Cacciola G, Pirato F, Bosco F, De Martino I, Sabatini L, et al. Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: a systematic review. Eur J Orthop Surg Traumatol. 2024;34:47–57.

    Article  PubMed  Google Scholar 

  35. Aprato A, Joeris A, Tosto F, Kalampoki V, Stucchi A, Massè A. Direct and indirect costs of surgically treated pelvic fractures. Arch Orthop Trauma Surg. 2016;136:325–30.

    Article  PubMed  Google Scholar 

  36. Ma L, Ma L, Chen Y, Jiang Y, Su Q, Wang Q, et al. A cost minimization analysis comparing minimally–invasive with open reduction surgical techniques for pelvic ring fracture. Exp Ther Med. 2019;17:1802–12.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Kadirli State Hospital, Osmaniye, Turkey

    Emre Sönmez

  2. Department of Orthopaedics and Traumatology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey

    Mehmet Yiğit Gökmen & Özhan Pazarcı

Authors
  1. Emre Sönmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Yiğit Gökmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Özhan Pazarcı
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ES and ÖP contributed to the study’s conception and design. ES, MYG, and ÖP performed material preparation, data collection, and analysis. ES and MYG wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mehmet Yiğit Gökmen.

Ethics declarations

Ethical approval

Ethical approval was obtained from the Adana City Training and Research Hospital Clinical Research Ethics Committee on November 17, 2022, with decision number 2252. The patients’ rights rules of the Declaration of Helsinki were followed.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sönmez, E., Gökmen, M.Y. & Pazarcı, Ö. The effects of prophylactic administration of tranexamic acid on the operative time and the amount of blood transfused during open fixation of pelvis and acetabulum fractures. J Orthop Surg Res 19, 606 (2024). https://doi.org/10.1186/s13018-024-05100-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13018-024-05100-4

Keywords

Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X