1: J Trauma  1995 Apr;38(4):639-41 

Open tibia fractures in the splenectomized trauma patient: results of treatment
with locking, intramedullary fixation.

Sterett WI, Ertl JP, Chapman MW, Moehring HD.

University of California, Davis Medical Center, Department of Orthopaedic
Surgery, USA.

OBJECTIVE: To confirm our clinical impression that patients with traumatic
splenectomy had more complications in the treatment of open tibia fractures, we
retrospectively reviewed the records of patients with open tibia fractures
treated between 1989 and 1992. MATERIALS AND METHODS: Eight patients with open
tibia fractures and traumatic splenectomies were compared to 43 patients with
open tibia fractures and intact spleens. The latter group typically underwent
either exploratory laparotomy or peritoneal lavage. The two groups were similar
with respect to age, mechanism of injury, fracture wound classification, and
injury severity score (22.4 in the splenectomized patients, 18.6 in the
control). All tibia fractures were treated with a nonreamed, cross-locked,
titanium intramedullary nail, and all patients were treated according to the
same protocol of antibiotic therapy. Patients were followed for two years or
until roentgenographic and clinical union. RESULTS: The splenectomized patients
had a significantly higher incidence of chronic osteomyelitis (25% vs. 4.6%),
and the need for additional tibial surgeries to achieve union (75% vs. 16%).
Time to union averaged 11.3 months in the splenectomized group and 7.6 months in
the patients with intact spleens. CONCLUSIONS: The increased risk for chronic
osteomyelitis and other complications of tibial fracture in the splenectomized
patients should be taken as an argument favoring splenic, repair, when possible,
rather than splenectomy in victims of blunt multiple trauma.

PMID: 7723110 [PubMed - indexed for MEDLINE]