A meta-analysis of the incidence of intra-abdominal injuries associated with thoracic or lumbar flexion-distraction injuries

Abstract

Background: Intra-abdominal injuries (IAIs) are often associated with thoracic or lumbar flexion distraction injuries (TLFDIs) or Chance fractures. The incidence ranges from 10 to 50 % in previous literature.

Aim: To synthesize data about the incidence of IAIs associated with TLFDIs.

Methods: We searched PubMed, WOS, and Cochrane databases for all studies reporting the incidence of IAIs associated with TL FDIs. The primary outcome was the overall pooled incidence of IAIs, surgical intervention, and specific organ injuries. A subgroup analysis was done for studies that included adults, pediatrics, and mixed populations. We assessed the methodological quality of the included studies using the Newcastle-Ottawa Scale. We used A random effects model to calculate pooled incidence rates and heterogeneity. This systematic analysis followed PRISMA guidelines.

Results: A total of eight retrospective studies with 652 patients met the inclusion criteria. The pooled incidence of overall IAIs associated with TLFDIs was 36.2 % (95 % CI: 32.2 % %-57.2 %), with high heterogeneity (I² = 90.71 %, p = 0.0001). The incidence of surgical interventions was 29.03 % (95 % CI: 22.0 %-48.3 %), with high heterogeneity (I² = 92.3 %, p < 0.0001). Small bowel injuries occurred in 19.17 % of cases, large bowel injuries in 10.92 %, liver injuries in 7.6 %, splenic injuries in 7.2 %, kidney injuries in 5.36 %, and pancreatic injuries in 3.7 %. Pediatric populations showed significantly higher rates of IAAs (55.8 % vs. 23.03 %) and surgical intervention (45.5 % vs.10.6 %) than adults.

Conclusion: The pooled incidence of IAAs associated with TL FDIs is 36.2 %, and surgical intervention is 29.03 %. Small bowels, large bowels, liver, and splenic injuries were the most frequent injuries. These rates are probably overestimated due to the retrospective design of studies and the variability in the definition of TLFDIs. Therefore, prospective, well-designed studies are needed to estimate the true incidence of IAAs associated with TLFDIs accurately.

Keywords: Bowel injury; Flexion distraction injury; Fractures; Intra abdominal injury; Lumbar; Mesenteric injury; Thoracic.