Specific Fracture Configurations Predict Sexual and Excretory Dysfunction in Men and Women 1 Year After Pelvic Fracture

Hidden dangers of pelvic fracture: A meta-analysis on urinary tract injury incidence and risk factors

BACKGROUND

Pelvic fractures are often associated with significant morbidity, including injuries to the urinary tract. Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management. This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.

AIM

To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.

METHODS

A systematic search of PubMed, EMBASE, Scopus, and the Cochrane Library was conducted without date restrictions. Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included. Data extracted included demographics, injury mechanism, pelvic fracture type, urinary tract injury incidence, mortality, and discharge disposition. Review Manager 5.4 was used for data analysis.

RESULTS

Ten studies comprising 22700 patients were included. The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88% (95%CI: 6.20%-7.55%). Vehicle, motorcycle, and pedestrian accidents were identified as risk factors for urinary tract injury, with relative risks (RR) of 1.08 (95%CI: 1.06-1.11), 1.89 (95%CI: 1.78-2.00), and 1.53 (95%CI: 1.20-1.95), respectively. Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury [odds ratio (OR) 1.94, 95%CI: 1.09-3.44 and OR 5.53, 95%CI: 4.67-6.54, respectively)]. Patients without urinary tract injury were more likely to be discharged home (RR 0.79, 95%CI: 0.67-0.92). Mortality was higher in patients with urinary tract injury (OR 1.92, 95%CI: 1.77-2.09).

CONCLUSION

Urinary tract injury occurs in nearly 7% of patients with pelvic fractures. Motorcycle accidents, pubic fractures, and pelvic ring disruptions are significant risk factors. Urinary tract injury following pelvic fracture is associated with increased mortality.

First safety outcomes for rigicon conticlassic® artificial urinary sphincter

The Rigicon ContiClassic® is a new sphincteric device designed to treat male stress urinary incontinence. This study evaluates the surgical outcomes and safety profile of the first 116 patients who received the implant between September 2021 and April 2022. Data were collected from patient information forms completed at the time of the implant and submitted by implanting surgeons, nursing staff in the Operating Room or company representatives present during the surgery. The study analyzed patient demographics, surgical details, and etiology of incontinence. The mean age of patients was 68.3 years +/- 9.65 yrs. Minimum age was 23 and maximum age was 83. The most common reason for implantation was urinary incontinence (58.6%) after radical prostatectomy. The results showed a revision rate of 6.90%, with three cases of fluid loss, four cases of iatrogenic mistaken sizing, and one case of patient dissatisfaction. There were no reported infections. Kaplan-Meier calculation showed survival rate of 93.2% at 12 months. This study shows the early safety outcomes for the Rigicon ContiClassic® sphincter device to be comparable to others presently on the market.

Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective

Introduction

Optimal management of transverse sacral fractures (TSF) remains inconclusive. These injuries may present with neurological deficits including cauda equina syndrome. We present our series of laminectomy for acute TSF with cauda equina compression.

Methods

This was a retrospective chart review of all patients that underwent sacral laminectomy for treatment of cauda equina compression in acute TSF at our institution between 2007 through 2023.

Results

A total of 9 patients (5 male and 4 female) underwent sacral laminectomy to decompress the cauda equina in the setting of acute high impact trauma. Surgeries were done early within a mean time of 5.9 days. All but one patient had symptomatic cauda equina syndrome. In one instance surgery was applied due to significant canal stenosis present on imaging in a patient with diminished mental status not allowing proper neurological examination. Torn sacral nerve roots were repaired directly when possible. All patients regained their neurological function related to the sacral cauda equina on follow up. The rate of surgical site infection (SSI) was 33%.

Conclusion

Acute early sacral laminectomy and nerve root repair as needed was effective in recovering bowel and bladder function in patients after high impact trauma and TSF with cauda equina compression. A high SSI rate may be reduced by delaying surgery past 1 week from trauma, but little data exists at this time for clear recommendations.

Functional Outcomes and Quality of Life After Sacrum Fractures Managed by Either Operative or Conservative Approaches: A Case Series With One-Year Follow-Up

Background Pelvic fractures caused by high-energy trauma, such as motor vehicle accidents or falls from a considerable height, commonly lead to sacral fractures. Approximately a quarter of sacral fractures are linked to neurological injury, and overlooking these fractures may result in neurological issues such as sexual dysfunction, hindered lower limb functionality, and urinary and rectal difficulties. The main goal of this study is to introduce our patient group who underwent either operative or nonoperative treatment for sacral fractures, with a follow-up period of one year, and assess their functional outcomes. Methodology This is a retrospective review of prospectively collected data from a consecutive series of patients at the Apex Trauma Centre, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. A consecutive series of 24 patients (17-55 years old) with sacral fractures treated either operatively or nonoperatively from 2018 to 2023 was studied. A total of 20 patients were available for follow-up questionnaires, and 20 patients participated in a physical examination. Time to final follow-up averaged 27.19 months (range = 12-57 months). The personal data of each patient was collected, including gender, age, comorbidities, concomitant injuries, mechanism of injury, fracture pattern/classification, surgical or nonsurgical treatment, other surgeries, length of surgery, length of hospital stays, adverse events, complications, neurologic and/or motor deficits, bowel and bladder function, and mortality. At a minimum one-year follow-up, the Majeed score, Oswestry Disability Index (ODI) questionnaire, and Gibbon's classification were assessed. Results All fractures were healed. Five patients showed neurological weakness, with three patients having only paresthesia and two patients having lower limb weakness. The mean Majeed score was 75.4, representing a moderate clinical outcome. Final ODI scores averaged 10.6, representing mild disability among patients with sacrum fractures. Overall, 40% of sacrum fractures were associated with sexual dysfunction, with 30% of females and 50% of males reporting this issue. There was no significant difference (p > 0.05) between operated and conservatively managed sacrum fractures concerning ODI scores, neurological deficit, and sexual dysfunction. Conclusions Both male and female patients with traumatic sacrum fractures experienced a significant decrease in their quality of life and sexual function at least 12 months after their surgery. Sacrum fractures are associated with an increased prevalence of sexual dysfunction and bowel/bladder incontinence. Our study findings indicate that patients with sacrum fractures experience similar functional outcomes and incidences of sexual dysfunction irrespective of whether they are managed operatively or conservatively.

Management of Neglected Pubic Symphysis Diastasis and Sacroiliac Joint Disruption With Erectile Dysfunction in Polytrauma: A Case Report

Pelvic fractures are the most common among patients sustaining high-energy trauma. They are associated with high morbidity and mortality rates, often because of high blood loss and injury to the lumbosacral plexus, genitourinary system, and gastrointestinal system. The age, complexity of the pelvic fracture, and pubic symphysis diastasis would represent risk factors for erectile dysfunction after major and neglected pelvic injuries; the neglected pelvic ring injuries could cause disabilities that manifest with symptoms like pain, lower limb length discrepancy, standing or sitting imbalance and even sexual dysfunction. Herein, we report a case of a young adult who sustained polytrauma and was diagnosed with neglected pubic symphysis diastasis, sacroiliac joint disruption, and erectile dysfunction. The patient regained erectile function after the surgical management of pubic symphysis diastasis and sacroiliac joint disruption.

Erectile dysfunction after acetabular fracture

Objectives

To determine the rate of erectile dysfunction in male patients who have sustained an acetabular fracture with no previously identified urogenital injury.

Design

Cross-sectional survey.

Setting

Level 1 Trauma Center.

Patients/Participants

All male patients treated for acetabular fracture without urogenital injury.

Intervention

The International Index of Erectile Function (IIEF), a validated patient-reported outcome measure for male sexual function, was administered to all patients.

Main Outcome Measurements

Patients were asked to complete the International Index of Erectile Function score for both preinjury and current sexual function, and the erectile function (EF) domain was used to quantify the degree of erectile dysfunction. Fractures were classified according the OTA/AO classification schema, fracture classification, injury severity score, race, and treatment details, including surgical approach were collected from the database.

Results

Ninety-two men with acetabular fractures without previously diagnosed urogenital injury responded to the survey at a minimum of 12 months and an average of 43 ± 21 months postinjury. The mean age was 53 ± 15 years. 39.8% of patients developed moderate-to-severe erectile dysfunction after injury. The mean EF domain score decreased 5.02 ± 1.73 points, which is greater than the minimum clinically important difference of 4. Increased injury severity score and associated fracture pattern were predictive of decreased EF score.

Conclusion

Patients with acetabular fractures have an increased rate of erectile dysfunction at intermediate-term follow-up. The orthopaedic trauma surgeon treating these injuries should be aware of this as a potential associated injury, ask their patients about their function, and make appropriate referrals.

Level of Evidence

III.

Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System

BACKGROUND

This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury.

METHODS

Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS).

RESULTS

No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020).

CONCLUSION

The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.

Lower urinary tract injuries in patients with pelvic fractures at a level 1 trauma center - an 11-year experience

BACKGROUND

Urological injuries can occur in patients with pelvic fractures. Treatment recommendations lack solid evidence and is often pragmatical. There is a continuous need to describe short- and long-term morbidity following lower urinary tract trauma.

OBJECTIVE

To describe incidence, diagnosis, treatment, and morbidity following lower urinary tract injuries in pelvic fractures.

PATIENTS AND METHODS

Retrospective study including patients with pelvic, including acetabular, fractures admitted to a Level I Trauma Centre covering 2.8 million citizens between 2009 and 2020. Outcome measurements comprised primary management, treatment trajectory, short- and long-term complications and outcomes.

RESULTS

A total of 39 (5%) patients with pelvic fractures had concomitant urethral and/or bladder injuries, and one patient with an acetabular fracture had a bladder injury. The management of urethral injuries varied vastly, and complete urethral ruptures were associated with severe short- and long-term complications. Only one patient with bladder injury experienced severe long-term complications.

CONCLUSIONS

Management of lower urinary tract injuries in patients with major pelvic fractures remains a major challenge. Special attention should be focused on urethral injuries where we uncovered an unsystematic treatment and follow-up even in a highly experienced centre, although this is also attributed to complicated multidisciplinary patient trajectories. There is a continuous need to reduce long-term complications following urethral trauma which should be addressed in multicenter studies.

Understanding sexual health concerns in women after traumatic pelvic fracture

INTRODUCTION

While there is a well-known association between pelvic fracture and sexual dysfunction, few studies discuss the treatment patterns and utilization of healthcare services following injury. Those that do exist pertain to men. How women experience sexual dysfunction after traumatic injury and how they navigate the healthcare system is currently not well documented in the literature. This study aims to understand the prevalence and spectrum of sexual health issues in women after pelvic fracture, and to highlight barriers associated with accessing care for these concerns.

MATERIALS AND METHODS

Women admitted and treated for traumatic pelvic fractures at a single Level 1 trauma center over a 6-year period were invited to participate in an electronic cross-sectional survey. Sexual health issues and care-seeking behaviors around sexual health were assessed. Inverse probability weighting based on available common data points in the registry was utilized to adjust for nonresponse bias. All data presented are of weighted data unless otherwise specified.

RESULTS

Of the 780 potential subjects, 98 women responded to the survey (12.6% crude response rate). With weighting, 71% of responders were white and 42% had private insurance, with a mean age at the time of injury of 42.2 years (SD 22.4) and median time since the injury of 45 months (interquartile range: 30.0, 57.4). 49.5% stated that sexual function was important to very important to their quality of life, with an additional 25.3% reporting it was moderately important. Of responders, 59.0% (95% confidence interval: 47.1%-71.0%) reported de novo postinjury sexual dysfunction. Specific complaints included dyspareunia (37.1%), difficulty with sexual satisfaction (34.4%), difficulty with sexual desire (31.3%), difficulty with orgasm (26.0%), and genital pain (17.8%). Of those with postinjury sexual dysfunction, 30.4% of women reported spontaneous resolution without treatment. An additional 15.4% indicated that they have continued concerns and desire treatment. Only 11.6% of women stated they had received treatment, all patients with access to insurance. Of those with postinjury sexual dysfunction, 60.8% had sexual health discussions with providers, 83.3% of which were patient-initiated. Common reasons why patients with sexual dysfunction did not raise the topic of sexual health with providers included embarrassment/fear (23.6%), assuming the issue would resolve with time (23.5%), sexual health not being a health priority (22.4%), and lack of information about the condition or available treatments (19.9%).

CONCLUSION

Sexual dysfunction is common in women after traumatic pelvic fracture, with patients experiencing dysfunction in multiple domains. Concerns are inadequately addressed in the healthcare setting due to several modifiable barriers at both the patient and provider levels. Standardization in the postinjury recovery period is needed to better address patients' sexual health concerns.

Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture

OBJECTIVES

To quantify the severity of urinary and sexual dysfunction and to evaluate the relationship between urinary and sexual dysfunction, injury, and treatment factors in patients with pelvic fracture.

DESIGN

Prospective cohort study.

SETTING

Level 1 trauma center.

PATIENTS/PARTICIPANTS

One hundred thirteen patients with surgically treated pelvic fracture (65.5% OTA/AO 61B fractures; 7 open fractures; 74 men).

INTERVENTIONS

Surgical pelvic stabilization.

MAIN OUTCOME MEASURES

The 36-Item Short Form Health Survey and International Consultation Incontinence Questionnaire responses were collected at baseline, 6 months, and 1, 2, and 5 years. Patients were scored on symptoms of voiding and incontinence, and filling (for women), to derive urinary function. Sexual function was scored as a single domain. Both genders reported urinary and sexual bothersome symptoms. Regression analysis was used to isolate the importance of predictive factors on urinary and sexual function, urinary and sexual bother, and their impact on quality of life.

RESULTS

Patients with pelvic fracture have significant urinary and sexual dysfunction, which is sustained or worsens over time. Male urinary function was predicted by Injury Severity Score (P = 0.03) and 61C fracture (odds ratio: 3.23, P = 0.04). Female urinary function was predicted by urinary tract injury at admission (odds ratio: 7.57, P = 0.03). Neurologic injury and anterior fixation were identified as significant predictors for male sexual function and sexual bother, whereas urological injuries were important in predicting female urinary and sexual bother (P < 0.01). Sexual function (P = 0.02) and sexual bother (P < 0.001) were important predictors of overall mental well-being in men.

CONCLUSIONS

Urinary and sexual dysfunction are prevalent and sustained in men and women and do not follow the prolonged slow recovery trajectory seen in physical function. Male urinary and sexual dysfunction was closely tied to neurologic injury, whereas female urinary and sexual dysfunction was predicted by the presence of a urinary tract injury. Urinary and sexual dysfunction were important to overall mental well-being in men.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Surgical Approaches for Isolated Acetabulum Fracture on Sexual Functions: A Prospective Study

OBJECTIVES

To investigate the effects of surgical modalities for isolated acetabular fractures on the sexual functions of patients and their partners.

DESIGN

Prospective.

SETTING

Level I trauma centre.

PATIENTS/PARTICIPANTS

Sixty-five patients who had undergone open reduction and internal fixation because of isolated acetabular fractures who were sexually active before, together with their partners.

INTERVENTION

Patients operated on for isolated acetabular fractures were divided into 3 groups according to surgical approaches: the Kocher-Langenbeck approach (n = 36), ilioinguinal approach (n = 16), and modified Stoppa approach (n = 13).

MAIN OUTCOME MEASUREMENTS

Sexual functions of patients and their partners were evaluated with the 5-item version of the International Index of Erectile Function score and Female Sexual Function Index score preoperatively and at the postoperative first year after the rehabilitation period.

RESULTS

The mean age of the patients was 41.8 ± 13.0 (18-69) years. In male patients, the mean 5-item version of the International Index of Erectile Function score had changed from 24.3 to 20.0 at the postoperative first year and the decrease in sexual function scores was less with the Kocher-Langenbeck approach. In female patients, the Female Sexual Function Index scores had decreased statistically significantly from 24.9 to 18.3 at the postoperative first year, but there was no statistically significant difference between surgical groups. Both male and female patients' partners' sexual function scores were also decreased at the postoperative first year.

CONCLUSIONS

As a result of our study, it was observed that the posterior approach is more advantageous than anterior approaches in preserving the sexual functions of male patients in acetabular fracture surgery. However, the surgical approach did not affect the sexual functions of female patients.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

INTRODUCTION

Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5-33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring.

METHODS

Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: "Pelvic fracture," "Pelvic Ring Fracture," "Pelvic Ring Trauma," "Pelvic Ring injury," "Sexual dysfunction," "Erectile dysfunction," "dyspareunia," and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)?

RESULTS

After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected.

DISCUSSION

Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated.

CONCLUSION

There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

[Pelvic fracture and urogenital dysfunction in women: A literature review]

INTRODUCTION

The consequences of a pelvic fracture on pelvic statics and sexuality in women are often overlooked and relegated to secondary care.

OBJECTIVE

To carry out a state of knowledge on disorders of pelvic statics and sexuality in patients with a history of pelvic fracture: incidence, risk factors, management.

METHODS

Literature review on the Pubmed, Medline, Embase and Cochrane database using the following keywords and MeSH terms: pelvis floor dysfunction, urinary dysfunction, sexual dysfunction, pelvic organ prolapse, in association with the terms pelvic fracture, pelvic trauma.

RESULTS

Among the 270 initial articles, 21 were selected. Finally, one retrospective cohort study has evaluated the impact of pelvic fracture on the onset of a genital prolapse, 2 comparative retrospective studies and one prospective study focused on the impact of pelvic fracture on lower urinary tract symptoms. One comprehensive review studied pelvic fracture and sexuality outcomes. The incidence of prolapse following pelvic fracture could not be identified. The incidence of lower urinary tract symptoms varies between 21 and 67% with a significant difference for urinary urgency without leakage (P=0.016) and SUI (P=0.004). The incidence of sexual disorders varies between 21 and 62% with a predominance of dyspareunia. The mechanism of the trauma is thought to be a contributing factor, as well as the damage of the pubic symphysis (RR 4.8 95% CI 2.0-11.2).

CONCLUSION

The evaluation of urogenital, sexual and anorectal dysfunctions following trauma to the pelvis has so far been little explored in the literature. Future prospective studies are to be carried out to improve patient care.

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

OBJECTIVE

To investigate the rate of erectile dysfunction (ED) after pelvic ring fracture (PRF).

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus and Web of Science Library databases was conducted in January 2020. Included were original studies performed on humans assessing ED after PRF according to the 5-item International Index of Erectile Function (IIEF-5) questionnaire and fracture classification following Young and Burgess, Tile or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association. Furthermore, interventional cohort studies assessing the effect of penile rehabilitation therapy with phosphodiesterase-5-inhibitors (PDE-5-I) on IIEF-5 scores compared before and after treatment were included. Results were presented as forest plots of proportions of patients with ED after PRF or mean changes on IIEF-5 questionnaires before and after penile rehabilitation. Studies not included in the quantitative analysis were narratively summarised. Risk of bias assessment was conducted using the revised tool for the Quality Assessment on Diagnostic Accuracy Studies.

RESULTS

The systematic literature search retrieved 617 articles. Seven articles were included in the qualitative analysis and the meta-analysis. Pooled proportions revealed 37% of patients with ED after suffering any form of PRF (result on probability scale pr=0.37, 95% CI: 0.26 to 0.50). Patients after 3 months of penile rehabilitation therapy reported a higher IIEF-5 score than before (change score=6.5 points, 95% CI: 2.54 to 10.46, p value=0.0013).

CONCLUSION

Despite some heterogeneity and limited high-quality research, this study concludes that patients suffering from any type of PRF have an increased risk of developing ED. Oral intake of PDE-5-I for the purpose of penile rehabilitation therapy increases IIEF-5 scores and may relevantly influence quality-of-life in these patients.

PROSPERO REGISTRATION NUMBER

CRD42020169699.

Testicular Dislocation After Unstable Pelvic Ring Injury

Reproductive and genitourinary complications following pelvic ring injuries have been described; however, testicular dislocation is rare and can cause significant morbidity if not managed appropriately. We describe a case of testicular dislocation after pelvic ring injury and outline the subsequent management and outcome, and seek to identify areas of improvement to ensure expedient and appropriate care in the setting of these injuries.

Our case describes a 29-year-old male who presented to a level-one trauma center following a motorcycle collision. An anteroposterior compression type II rotationally unstable pelvic ring was identified on imaging. He was hemodynamically unstable and computed tomography (CT) with angiography was ordered. Arterial extravasation was noted from the bilateral anterior internal iliac arteries, which were subsequently embolized by interventional radiology. However, no concomitant genitourinary injury was identified at the time of CT. After resuscitation, the pelvis was stabilized with an anterior symphyseal plate and bilateral sacroiliac screws. During the anterior pelvic approach, the patient’s dislocated testicle was surprisingly discovered inferior to the pubis. Urology was consulted intra-operatively, and the testicle was successfully relocated. At the final follow-up, the pelvic ring was healed without any noticeable urogenital complication.

While testicular dislocation has been reported in the setting of pelvic ring injury, a paucity of information exists regarding management, implications, and areas for improvement in the identification of these injuries. Therefore, in cases of pelvic ring injury with significant trauma, radiologists, traumatologists, and orthopedic surgeons should adopt a multi-disciplinary approach in diligently attempting to rule out testicular dislocation pre-operatively. Intra-operatively, examination under anesthesia and careful operative technique are important in preventing iatrogenic injury.

Impact of Childhood Sexual Assault on Sexual Function in the Czech Male Population

Introduction

This study explores the impact of childhood sexual assault (CSA) on men's sexual function. There is limited understanding on the impact of CSA perpetrated against boys on later adult male sexual function, as there is a dearth of research on this topic. It was hypothesized that men reporting a history of CSA were more likely to report sexual function issues than men with no history of CSA.

Material and methods

A cross-sectional survey study of 1,004 Czech men aged between 15 and 85 years (M = 42.8 years; Standard deviation = 17.6 years) have been conducted. The participants anonymously answered a questionnaire on multiple aspects of their life and sexuality. This questionnaire included sought data on history of CSA and self-reported intravaginal ejaculation latency time and the 5-item International Index of Erectile Function.

Results

25 men (2.5%) indicated a history of CSA. 71% of the perpetrators where known by the victims, with a minority declaring the crime to authorities (37.5%). Half of those reporting assault also reported sexual function issues in the present or at some time in their life. Significant correlations were recorded between a history of CSA and erectile dysfunction but not significantly with premature ejaculation.

Conclusions

Men who reported a history of CSA are more likely to report sexual function issues than those who do not. The identified association between CSA and sexual function issues in adult life contributes to the small body of literature on the topic. When taking a sexual history, it is recommended to practitioner to include questions about CSA, considering its correlation with erectile dysfunction. An understanding of the relationship between CSA and adult sexual function helps practitioner to improve his patient's well--being and life satisfaction.

Kamnerdsiri WA, Fox C, Weiss P, et al. Impact of Childhood Sexual Assault on Sexual Function in the Czech Male Population. J Sex Med 2020;8:446–453.

Part 1: Outcome of Posterior Pelvic Ring Injuries and Associated Prognostic Factors - A Five-Year Retrospective Study of One Hundred and Sixty Five Operated Cases with Closed Reduction and Percutaneous Fixation

PURPOSES

The aim of this study was to evaluate: 1. the outcome of pelvic ring fractures treated by closed reduction and percutaneous fixation, 2. the prognostic factors associated with a poor quality reduction, 3. the prognostic factors associated with ilio-sacral screws misplacement and 4. the prognostic factors associated with nonunion.

METHODS

Data from medical charts for all patients admitted with unstable posterior pelvic ring injuries from 2009 to 2013 were extracted. A total of 165 patients with a mean age of 40 years were included. One hundred and five patients were reviewed at a mean of 32 months of follow-up. The prognostic factors analyzed were clinical and radiological factors. Tile B and Tile C pelvic ring fractures were compared and analyzed separately. Then specific statistical analysis was performed using a logistic regression model to eliminate confusion factors.

RESULTS

An excellent or good clinical result was achieved for 94 patients (90%). An excellent or good reduction was achieved for 141 patients (85%). Nonunion rate, smoking patients, bad reductions, age of patients and ISS score were significantly higher in Tile C group. To eliminate confusion factors we used a multivariate analysis logistic regression model. Only unstable vertical bilateral posterior injuries (Tile C2 and C3) were independent prognostic factors for unsatisfactory reduction (p = 0.001; OR = 4.72; CI 95% [2.08-16.72]). Screw misplacement was recorded for 30 patients (16%) and sacral dysmorphia was an associated prognostic factor (p = 0.0001; OR = 15.6; CI95% [3.41-98.11]). Nonunion was recorded for ten patients (6%) and smoking was an associated prognostic factor (p = 0.01, OR = 5.12; CI95% [1.1-24.1]).

CONCLUSIONS

Posterior pelvic ring fractures treated by closed reduction and percutaneous fixation are associated with excellent/good clinical results if excellent/good reduction and bone healing are achieved without screw misplacement. Bilateral unstable vertical posterior pelvic ring injuries, and sacral dysmorphia are risk factors for bad quality reduction and screw misplacement respectively.

Urethral injury in major trauma

Urethral injury in major trauma is infrequent, with complex problems of diagnosis and treatment. The aims of this study are to determine the incidence and epidemiological factors relating to urethral injury in major trauma, as well as determine if any additional prognostic factors are evident within this cohort of patients. A retrospective review of patients sustaining urethral injury following major trauma was made over a 6-year period, from 2010 to 2015. Quantitative analysis was made using the national trauma registry for England and Wales, the Trauma Audit and Research Network (TARN) database, identifying all patients with injury codes for urethral injury. 165 patients with urethral injuries were identified, over 90% were male, most commonly injured during road traffic accidents and with an associated overall mortality of 12%. Urethral injury in association with pelvic fracture occurred in 136 patients (82%), representing 0.6% of all pelvic fractures, and was associated with double the rate of mortality. Urethral injury was associated with unstable pelvic fractures (LC2, LC3, APC3, VS, CM) but not with a specific pelvic fracture type. This study confirms the rare incidence of this injury in major trauma at 1 per 2 million population per year.

The relationship between injury mechanism and sexual dysfunction in surgically treated pelvic fractures

PURPOSE

The aim of the study was to identify the incidence of new sexual dysfunction reported by the patient in surgical treatment of pelvic ring injuries, and to describe the relationship between new sexual dysfunction and type of fracture.

METHODS

Ninety-five patients who were operated for pelvic fracture were included in the study. Patients were evaluated according to age, gender, marital status, body mass index, trauma mechanism, fracture classification, genitourinary injury, accompanying injury, injury severity score, surgical technique, fixation material, duration of operation, functional outcomes, blood loss, complications, and sexual dysfunction. Functional outcomes were assessed with Female Sexual Functioning Index (FSFI), International Index of Erectile Function-5 (IIEF5), Arizona Sexual Experience Scale (ASEX), and Modified Majeed's pelvic outcomes grading scale (MPS).

RESULTS

Genitourinary symptoms were erectile dysfunction (ED) in 13 men, ejaculatory dysfunction in 9 men, and dyspareunia in 23 women. Urethral stricture developed in 4 males and 1 female with the urethral injury. FSFI score, ASEX score, and MPS score showed the statistically significant difference between the fracture types (p = 0.021, p = 0.032 and p = 0.020, respectively). There were no significant difference between fracture types in terms of the IIEF5 score, and no significant relationship between fracture type and ED development (p = 0.141).

CONCLUSION

Anteroposterior compression (APC) is the most common cause of sexual dysfunction in both sexes, independent of surgery. In addition, the most common cause of ED in men is vertical shear (VS). Especially patients with APC and VS injuries should be multidisciplinary evaluated with gynecology, urology, and psychiatry departments.

The impact of surgery for trochanteric femur fracture on sexuality in men and their female partners

PURPOSE

This study was aimed to investigate the effects of trochanteric femur fracture treatment methods on erectile functions of the patients and on sexual functions with their female partners.

MATERIALS AND METHODS

A total of 43 patients with trochanteric femur fracture who underwent proximal femoral nail (PFN) or proximal femur locking compression plate (PF-LCP) surgery were included in the study. The PFN implant was applied to group 1 ( n = 23) and the PF-LCP implant to group 2 ( n = 20). All the patients and their female partners completed the 5-item version of the International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index (FSFI) preoperatively and at 1 year postoperatively after the rehabilitation period.

RESULTS

The mean preoperative IIEF-5 and FSFI score was 21.910.9 and 21.911.1, 72.319.7 and 70.516.2 for the PFN and PF-LCP treatment groups, respectively, and at postoperative 1 year after rehabilitation, change in IIEF-5 score and FSFI score of each group was -6.512.1 versus -3.811.6, ( p < 0.001) and -16110.7 versus -6.314, ( p = 0.001), respectively.

CONCLUSION

These data show that trochanteric femur fractures treated with PFN or PF-LCP had a negative impact on sexual function. PF-LCP had a greater negative effect than PFN on sexual function.

A review of the revised Functional Capacity Index as a predictor of 12 month outcomes following injury

The measurement of functional outcomes following severe trauma has been widely recognised as a priority for countries with developed trauma systems. In this respect, the Functional Capacity Index (FCI), a multi-attribute index which has been incorporated into the most recent Abbreviated Injury Scale (AIS) dictionary, is potentially attractive as it offers 12-month functional outcome predictions for patients captured by existing AIS-coded datasets. This review paper outlines the development, construction and validation of the predictive form of the FCI (termed the pFCI), the modifications made which produced the currently available 'revised' pFCI, and the extent to which the revised pFCI has been validated and used. The original pFCI performed poorly in validation studies. The revised pFCI does not address many of the identified limitations of the original version, and despite the ready availability of a truncated version in the AIS dictionary, it has only been used in a handful of studies since its introduction several years ago. Additionally, there is little evidence for its validity. It is suggested that the pFCI should be better validated, whether in the narrow population group of young, healthy individuals for which it was developed, or in the wider population of severely injured patients. Methods for accounting for the presence of multiple injures (of which two have currently been used) should also be evaluated. Many factors other than anatomical injury are known to affect functional outcomes following trauma. However, it is intuitive that any model which attempts to predict the ongoing morbidity burden in a trauma population should consider the effects of the injuries sustained. Although the revised pFCI potentially offers a low-cost assessment of likely functional limitations resulting from anatomical injury, it must be more rigorously evaluated before more comprehensive predictive tools can be developed from it.

Prominent metalware from pelvic surgery causing dyspareunia

We present a case of female dyspareunia secondary to metalware placement during extensive pelvic surgery following a motor vehicle accident. The patient initially had an uneventful recovery from her operations. However, she noticed pain with vaginal intercourse, due to a screw tip which was palpable on vaginal examination. X-ray imaging confirmed long screws in the medial part of an anterior column plate, which were impacting on the anterior vaginal wall. Subsequent percutaneous removal of two screws resulted in resolution of her symptoms of painful vaginal intercourse. While the pain from mechanical irritation of the vagina was resolved, the patient continues to have difficulty with intercourse, which is related to hip pain as a result of her initial injury and complex pelvic surgery.

Epidemiology of Blunt Lower Urinary Tract Trauma With and Without Pelvic Fracture

OBJECTIVE

To assess the contemporary epidemiology of blunt trauma lower urinary tract injury (LUTI) and to evaluate outcomes in patients with and without associated pelvic fracture (PF).

METHODS

Patients presenting to our level I trauma center with PF and/or LUTI from blunt trauma from 2000 to 2014 were identified in our institutional trauma registry. Demographics, mechanism of injury, fracture configurations, hospital course, and outpatient disposition were analyzed.

RESULTS

Of 5518 PF patients, 233 (4.2%) had LUTI. Thirty-four patients had non-PF LUTI. There were 3.2% of men and 3.3% of women with PF who had bladder injuries (P = .94). Urethral injury was more common in men (2.0% vs 0.05%; relative risk 43.1). Pubic arch fractures were present in 87% of patients with urethral injuries, although only 1.5% of patients with pubic arch fractures had urethral injury. Isolated acetabular fractures were never associated with urethral injury and associated with only 2.6% of bladder injuries. Extraperitoneal bladder ruptures were more common in the PF group as compared to the non-PF LUTI group (39.1% vs 14.7%, P < .01). Intensive care unit length of stay and hospital length of stay for PF vs non-PF patients were 7.1 ± 8.1 vs 2.8 ± 5.3 days (P < .01) and 13.5 ± 13.4 vs 7.7 ± 8.4 days (P = .01), respectively.

CONCLUSION

These data suggest that the contemporary incidence of PF LUTI is lower than previously reported. The presence of PF in patients with LUTI is associated with more severe overall injuries, longer hospital stays, and increased rates of inpatient complications.

Nonunions and malunions of the pelvis

INTRODUCTION

Neglected pelvic fractures manifesting as pelvic nonunion or malunion are usually due to inadequate initial fixation or negligence of the injury because of increased attention towards other associated life-threatening conditions. The management of such injuries is complex. A systematic review was conducted to spot the clinical manifestations, evaluation, management and outcome of pelvic nonunion and malunion.

MATERIALS AND METHODS

Two databases ("Pubmed" and "Google scholar") were searched to look for relevant literature on pelvic non-union and malunion.  The search was limited to 'English language' and 'Human being'.

RESULTS

A total of 500 articles found, of which 10 articles were only reviewed which met the inclusion criteria. These articles discussed the clinical management and treatment of pelvic malunion and non-union following trauma without associated acetabular injury.

CONCLUSION

The usual presentations of pelvic non-union and malunion are pain, deformity, gait abnormality or instability. A detailed preoperative evaluation is essential as a majority of them have associated hip and spine injury which may be the cause of symptoms. Radiographs and 3D CT scans have helped surgeons in deciding the best way of management. The surgeries are usually complex and may need multiple-staged procedures. Soft tissue release, multiple osteotomies to achieve anatomical or near-anatomical reduction, augmentation of healing process using bone graft and stabilizing the nonunion/ osteotomy site using plates/screws/rods is the basic principle of surgery. Per-operative use of somato-sensory evoked potential evaluation helps the surgeon in preventing iatrogenic nerve injury. Despite these precautions and surgeries, most of the patients do not regain their preinjury functional activity.

Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures

PURPOSE

Thoracolumbar junction burst fractures remain a challenging problem due to controversy over the treatment choice of short- or long-segment posterior fixation. The aim of the present study was to compare life quality and sexual function of patients after short- and long-segment posterior fixations in the treatment of thoracolumbar junction burst fractures.

METHODS

In this prospective, randomized study, 24 sexually active male patients diagnosed with thoracolumbar junction burst fractures were randomly assigned to either the short-segment posterior fixation (SSPF) group or the long-segment posterior fixation group (LLPF). The exclusion criteria were rheumatological disease and spinal surgery history. There were no significant differences in age, body mass index or smoking habits between the groups. The life quality score of EQ-5D and the International Index of erectile function (IIEF-5) score of male patients and the Female Sexual Function Index (FSFI) score of female partners were recorded preoperatively and 1 year after surgery.

RESULTS

The mean age of patients in the SSPF and LSPF groups was 44.58 and 42.92 years, respectively. There were no statistically significant differences between the groups in the preoperative EQ-5D and IIEF-5 scores of male patients and the FSFI score of their partners. Postoperatively, the EQ-5D scores (p = 0.011) and IIEF-5 scores (p = 0.000) of male patients and the FSFI score of their partners (p = 0.001) were better in the short-segment group.

CONCLUSIONS

Patients treated with SSPF have better sexual function and life quality with their partners compared to those treated with LSPF. The main clinical relevance of this study is that the impact of the choice of short or long-segment treatment on postoperative sexual function and life quality should be considered by surgeons when performing posterior fixation after thoracolumbar junction burst fractures.

The incidence of erectile dysfunction after pelvic fracture urethral injury: A systematic review and meta-analysis

Background

Pelvic fracture urethral injury (PFUI) is associated with a high risk of erectile dysfunction (ED). The effect of the type of posterior urethral disruption repair on erectile function has not been clearly established. We systematically reviewed and conducted a meta-analysis of the proportion of patients with ED at (i) baseline after pelvic fracture with PFUI, (ii) after immediate primary realignment, and (iii) after delayed urethroplasty.

Methods

Using search terms for primary realignment or urethroplasty and urethral disruption, we systematically reviewed PubMed and EMBASE. A meta-analysis of the proportion of patients with ED was conducted assuming a random-effects model.

Results

Of 734 articles found, 24 met the inclusion criteria. The estimate of the proportion (95% confidence interval) of patients with ED after (i) PFUI was 34 (25–45)%, after (ii) immediate primary realignment was 16 (8–26)%, and after (iii) delayed urethroplasty was an additional 3 (2–5)% more than the 34% after pelvic fracture in this cohort.

Conclusions

After pelvic fracture, 34% of patients had ED. After primary endoscopic alignment, patients had a lower reported rate of ED (16%). Delayed urethroplasty conferred an additional 3% risk above the 34% associated with PFUI alone, with 37% of patients having de novo ED. The difference in de novo ED after primary endoscopic alignment vs. delayed urethroplasty is probably due to reporting differences in ED and/or patients with less severe injury undergoing primary realignment.

Urogenital disorders after pelvic ring injuries

Introduction

The close anatomical relationship between the skeletal and connective systems of the pelvis, neurological, and vascular structures and pelvic organs are predisposing factors for structural and functional damages of the urogenital system.

Materials and methods

We performed PUBMED and MEDLINE search using terms “pelvic ring trauma/disruption, bladder injury, urethral injury, sexual dysfunction”.

Results

The probability of damage of the pelvic organs increases along with the degree of disturbance of integrity of the pelvic ring. The most important risk factor of urogenital injuries is the rupture of the symphyseal joint. Patients with lesions of the urogenital system have a higher risk of mortality compared with patients without lesions of the urogenital system. Sexual dysfunctions along with urinary incontinence are a common consequence of the pelvic fracture in men and women.

Conclusions

Injuries of the urogenital organs during pelvic ring fractures have an important negative prognostic value in terms of morbidity and quality of life. A prerequisite for a successful therapeutic outcome in case of pelvic fractures with disturbance of pelvic ring integrity is cooperation of orthopedists and urologists, with possible early diagnosis and treatment of injuries of the urogenital organs.

High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries

BACKGROUND

Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction.

QUESTIONS/PURPOSES

We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI.

METHODS

We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years).

RESULTS

New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1.02-6.64; urinary OR, 4.6; 95% CI, 1.81-11.73).

CONCLUSIONS

Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment.

LEVEL OF EVIDENCE

Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Functional outcome 10 years after surgical treatment of displaced sacral fractures

STUDY DESIGN

Prospective, longitudinal single-cohort study of 28 patients with displaced sacral fractures treated with internal fixation.

OBJECTIVE

To describe the long-term functional outcome concerning neurological deficits in the lower extremities and urinary, bowel, and sexual functions after severe sacral fractures and to compare the long-term results with the results from a previously reported 1-year follow-up of the same patient cohort.

SUMMARY OF BACKGROUND DATA

Displaced sacral fractures may result in considerable functional morbidity. Problems concerning walking, urinary and bowel functions, and sexual dysfunctions have been reported in the short and medium term. Little is known, however, of the long-term morbidities in these patients.

METHODS

Twenty-eight patients from the 1-year follow-up cohort were prospectively followed for median 10 years (range, 8-13). Sensorimotor function was classified according to the American Spinal Injury Association (ASIA) score. Urinary voiding function was assessed with uroflowmetry, and bowel and sexual functions were assessed using a structured interview. For comparison with previous data from the 1-year follow-up, the Wilcoxon signed rank test for paired samples was used.

RESULTS

Twenty-six patients had persistent neurological deficits in the lower extremities; one patient was not testable and only 1 was asymptomatic. Compared with preinjury, 5 had slightly changed, 11 significantly changed, and 3 completely changed urinary function. Six had a slightly changed and 2 completely changed bowel pattern. Comparing the long-term results with the 1-year data showed no significant changes in neurological deficits (P = 0.47) and bowel function (P = 0.13), whereas urinary function had deteriorated in 39% (P = 0.005). Sexual dysfunctions were reported in 44% versus 38% at the 1-year follow-up.

CONCLUSION

A high rate of impairments was observed in this study; urinary and sexual problems deteriorated over time, whereas neurological deficits of the lower extremities and bowel function did not change. These severe problems should be addressed early in the rehabilitation period and the patients should be followed by adequate expertise for many years after the injury.

Functional outcomes in women after high-energy pelvic ring injury

OBJECTIVES

Residual dysfunction after pelvic trauma has been previously described, but limited functional outcome data are available in the female population after high-energy pelvic ring injury. The purposes of this study were to determine functional outcomes and to characterize factors predictive of outcome.

DESIGN

Prospective collection of functional outcomes data.

SETTING

Level I trauma center.

PATIENTS/PARTICIPANTS

Eighty-seven women with mean age of 33.5 years and mean Injury Severity Score of 23.1 were included. The Orthopaedic Trauma Association classification included 32 B-type and 55 C-type fractures. Four were open fractures and six had bladder ruptures.

INTERVENTION

Forty-nine patients were treated operatively and 38 nonoperatively.

MAIN OUTCOME MEASUREMENTS

Musculoskeletal Functional Assessment (MFA) questionnaires were completed after a minimum of 16 months and a mean of 41 months of follow-up.

RESULTS

The mean MFA score was 33. Only 15 women (17.2%) had MFA scores comparable with an uninjured reference value (9.3), and 34 (39.1%) had better than the reference value for prior hip injury (25.5). Anteroposterior compression injuries had worse scores versus other patterns (48.3 vs 31.0, P = 0.01), and trends toward worse outcomes were noted after symphyseal disruption (P = 0.11) and transsymphyseal plating (P = 0.09). Sacral fracture or sacroiliac injury, amount of initial or final displacement, and type of posterior ring treatment were not associated with MFA scores. Mean scores were 32.3 after surgery and 34.0 after nonoperative management (P = 0.67). Functional outcomes were not related to age or Injury Severity Score, but isolated pelvis fractures had better MFA scores (21.1 vs 35.5, P = 0.008) and worse MFA scores (41.7 vs 29.1, P = 0.004) were seen with other lower extremity fractures. Those with bladder ruptures (n = 6) also had poor outcomes, mean MFA 50.0 (P = 0.078).

CONCLUSIONS

Wide variation is seen in functional outcome of women after high-energy pelvic ring fracture as measured by the MFA with mean scores demonstrating substantial residual dysfunction. Better outcomes were noted after isolated fractures and in women who had not sustained other fractures in their lower extremities. History of bladder rupture or anteroposterior compression injury was associated with poor MFA scores.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pelvic ring injury is associated with sexual dysfunction in women

OBJECTIVES

Previous studies have reported a negative effect of pelvic trauma on genitourinary and reproductive function of women. However, fracture pattern, injury severity, and final fracture alignment have not been well studied. The purpose of this project was to describe sexual function in women after pelvic ring injury.

DESIGN

Cohort study: a prospective collection of sexual function data for women with prior pelvic ring injury versus control groups of uninjured women and other women from the orthopaedic trauma clinic.

SETTING

Level I trauma center.

PATIENTS/PARTICIPANTS

One hundred eighty-seven women younger than age 55 years with pelvic ring injury, including 101 B-type (61-B1: n = 25, B2: n = 69, B3: n = 7) and 86 C-type (61-C1: n = 56, C2: n = 18, C3: n = 12) fractures. Four had open fractures, and 23 had associated genitourinary injury.

INTERVENTION

Seventy-four were treated operatively. Surgical treatment was percutaneous in 62: iliosacral screws (n = 58), external fixation (n = 4), or both (n = 19). Open reduction and internal fixation was performed for the pubis symphysis (n = 27), sacroiliac joint (n = 2), and posterior ileum (n = 3).

MAIN OUTCOME MEASUREMENTS

Sexual function questionnaires were completed for 92 patients (49%) with minimum 12 months and mean 46 months follow-up.

RESULTS

Forty-eight patients (56%) reported pain with intercourse. Their mean Musculoskeletal Function Assessment was 44.3 versus 20.9 without dyspareunia (P < 0.0001). Seventy-eight percent of patients with B-type fractures and 43% of patients with C-type fractures had dyspareunia (P = 0.002). Dyspareunia occurred after 91% of anteroposterior compression injuries (P = 0.02) and in 79% with a symphyseal disruption treated with plate fixation (P = 0.005). All patients with bladder ruptures (n = 5) reported dyspareunia. Sacral fracture or sacroiliac injury, type of posterior treatment, and residual malalignment of the posterior ring were not associated with dyspareunia. Fourteen patients each had associated femur fractures and/or tibia fractures. Seventeen of them had pain during intercourse (P = 0.19 for association of femoral or tibial fractures with dyspareunia).

CONCLUSIONS

Dyspareunia is common in women after pelvic ring fracture. Women with pelvic ring injury are more likely to report dyspareunia than other female patients with musculoskeletal trauma. Dyspareunia was related to anteroposterior compression and B-type injuries. Symphyseal plate fixation is also associated with dyspareunia. Pain with intercourse was also noted in all patients with a history of bladder rupture. Poor functional outcomes as measured by Musculoskeletal Function Assessment scores were reported in women with dyspareunia.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Uterine prolapse after pelvic trauma: case report and literature review

Up to date, the connection of pelvic trauma with genital prolapse is not widely recognized. These cases could be classified in a group where disruption of normal anatomy of the pelvis is apparent (i.e., pelvic fracture), and in a second group, where pelvis remains unaffected by the pelvic trauma (i.e., seat belt-related injuries). The aim of the report is to describe the management of a 39-year-old nulliparous patient presenting with stage III uterine prolapse after pelvic trauma; the patient had a history of Mitrofanoff's procedure for neurogenic bladder followed by closure of the bladder neck and permanent suprapubic urinary catheter for intractable incontinence. The prolapse was managed with a mesh anterior colporraphy combined with sacrospinous hysteropexy. At 3 months follow-up, she is well with no prolapse recurrence.

Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma

PURPOSE

To assess the incidence of long- and short-term complications following internal iliac artery (IIA) embolization after blunt pelvic trauma.

MATERIALS AND METHODS

One hundred trauma patients with pelvic fractures underwent pelvic angiography from 1994 through 2006. Sixty-seven patients underwent IIA embolization. These patients were retrospectively identified for medical record review. Short- and long-term complications were defined as those occurring at less than or greater than 30 days, respectively. Complications and outcomes were assessed through chart review and, when possible, a standardized questionnaire. Patients who underwent IIA embolization were compared with matched control patients with blunt pelvic trauma who did not undergo pelvic arteriography. Individuals were matched by age, sex, year of admission, and injury scores.

RESULTS

There were no significant differences in skin necrosis, sloughing, pelvic perineal infection, or nerve injury between embolized and nonembolized patients within 30 days. There was no significant difference in claudication, skin ulceration, or regional pain at a mean of 18.4 months follow-up. In the long term, buttock, thigh, and perineal paresthesia occur at a significantly higher rate in embolized patients. Skin sloughing in the embolized patient group is an important but rare complication.

CONCLUSIONS

IIA embolization is an important means of controlling pelvic arterial hemorrhage. There is no significant increase in the risk of most evaluated long- and short-term complications in trauma patients who underwent IIA embolization versus those who did not. However, IIA embolization is associated with a marginally significantly increased rate of buttock, thigh, or perineal paresthesia.