Quality of life from return to work and sports activities to sexual dysfunction after surgical treatment of acetabular fractures

Quality of Life from Return to Work and Sport Activities to Sexual Dysfunction after Surgical Treatment of Pelvic Ring Fractures

BACKGROUND

Pelvic ring fractures are life-threatening injuries that have a severe impact on patients' lives. The aim of this clinical study was to evaluate the outcome of surgical treatment in terms of Quality of Life (QoL), return to work, functional results and sport activities, and post-operative sexual dysfunction.

METHODS

A retrospective study with patients retrieved from a Level 1 Trauma Center was performed. Minimum patient follow-up was 12 months: QoL was evaluated with the SF-12 (Short Form Survey) questionnaire, return to work with the Workplace Activity Limitation Survey (WALS), functional outcomes and sport activities with the Harris Hip Score and Tegner activity score, respectively, and sexual function damage with a 0-10 NRS.

RESULTS

Seventy-six patients (41 males and 35 females) were enrolled, with a mean age at surgery of 56.4 years (18-89 years). Overall, their quality of life remained significantly affected, with male patients reporting worse WALS outcomes (p = 0.036), sexual damage (p = 0.001), and SF-12 Bodily Pain (p = 0.046) than females. In particular, 70.7% of men and 45.7% of women reported sexual limitations, and only 53.7% returned to their job, with 35.2% losing their job as a consequence of the pelvic ring disruption.

CONCLUSIONS

An important deterioration in general health state, return to work, and sexual function was documented in patients treated surgically for pelvic trauma, especially in male patients. There are disabling secondary sequels at all levels beyond the mere functional scores, and both patients and clinicians should be aware and have the correct expectations.

Effects of Different Surgical Procedures on the Therapeutic Effects, Prognosis, and Major Complications of Acetabular Fractures in the Elderly of China: A Systematic Review and Meta-Analysis

Objective. Different surgical approaches were systematically evaluated to provide an evidence-based medical rationale for the application and promotion of acetabular fractures in the elderly of China. Methods. Randomized controlled trials (RCT) of different surgical methods in the treatment of elderly acetabular fractures were searched in the PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). The search time threshold was set from the time the database was created to the current time. Investigators obtained data independently, and the bias risk of each included writing was reviewed using the Cochrane Manual 5.1.0 criterion. The meta data was analyzed using RevMan 5.4 statistical package. Results. 6 RCT articles were included in the end. A total of 445 samples were analyzed by meta. All the six RCT literatures included in this meta-analysis reported the baseline status of patients, only 3 RCT mentioned “random assignment” without any explanation, and the rest did not mention “random” information. The five studies included all gave detailed intervention measures. The number and reasons of blind method and lost follow-up or withdrawal were not described in detail in 6 RCT articles. Through the meta-analysis excellent and good rate between the experimental group and the control group through 6 RCT studies, the heterogeneity test results were $\text{ch}{\text{i}}^2=6.11$ , $\text{df}=4$ , $\text{P}=0.19>0.05$ , and ${\text{I}}^2=35\%$ , without obvious heterogeneity at $Z=2.68$ and $P=0.007$ . These results suggested that the total hip arthroplasty application has the same excellent rate as other surgical treatment methods, indicating that total hip arthroplasty has a significant effect on the treatment of elderly acetabular fractures. Through the meta-analysis hip-joint function score, the heterogeneity test results were $\text{ch}{\text{i}}^2=56.16$ , $\text{df}=4$ , $P<0.00001$ , and $I^2=93\%$ , with obvious heterogeneity. The great difference was discovered in hip function score between total hip arthroplasty and other surgical methods, showing that total hip arthroplasty can greatly improve hip-joint function. Then, the incidence of hip complications between the experimental cases and the control cases was calculated by meta. The heterogeneity test results were $\text{ch}{\text{i}}^2=3.17$ , $\text{df}=4$ , $P=0.53>0.05$ , and $I^2=0\%$ , without remarkable heterogeneity at $Z=3.05$ and $P=0.002$ . This demonstrated that a significant difference was observed in the complication incidence, indicating that total hip arthroplasty displayed a lower incidence of hip-joint functional complications. Conclusion. Total hip arthroplasty has a good prognosis and a low complication rate in the treatment of acetabular fractures in the elderly. However, more studies and longer follow-ups are needed to further validate the findings of this study.