Are Fractures To The Bony Cage Protecting the Abdomen Associated with Splenectomy in Cases of Abdominal Trauma? A Cohort Study

Abstract Background The spleen is protected by the ribs anteriorly, the vertebral column posteriorly and the pelvis inferiorly. Fractures to this bony cage may indicate a high-grade splenic injury necessitating splenectomy. We aim to determine whether fractures to the bony cage protecting the abdomen are associated with splenectomy. Methods We performed a subgroup analysis of patients with splenic injury from a prospective trauma registry study named ‘Towards Improved Trauma Care Outcomes’ (TITCO) in India. Out of the 16047 patients enrolled in the TITCO study, 267 patients with splenic injury were included. Categorical variables were analyzed using the chi square test and logistic regression was used to assess the significance of continuous variables. A multivariate analysis was performed on the factors deemed clinically most significant. Results Patients with a higher grade of splenic injury were more likely to require splenectomy when adjusted for other variables (p value < 0.05). Patients with fractures to the vertebrae or pelvis had reduced odds of splenectomy on unadjusted analysis [Odds ratio 0.43 (0.19–0.94)], but this was not significant when adjusted for other variables. Conclusion In contradiction to our initial hypothesis, we found that fractures to the bony cage protecting the abdomen were not significantly associated with the splenectomy.