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Meshay IM, Robbins JB, Wainwright J, Sonstein J, Person J, Hagedorn JC. Delayed Presentation of Bowel Injury Associated with Pelvic Fragility Fracture in Patient with Bladder Sling: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00015. [PMID: 38241445 DOI: 10.2106/jbjs.cc.23.00599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
CASE An 85-year-old woman with a history of bladder mesh sling placement sustained a pelvic fracture and extraperitoneal bladder rupture after a ground-level fall. The patient underwent cystorrhaphy and percutaneous anterior column screw placement. Free air was identified on abdominal computed tomography scan on postoperative day 5. Exploratory laparotomy revealed a sigmoid colon perforation and extensive bowel adhesions to the anterior pelvis. CONCLUSION This is the first report describing bowel injury and associated bladder rupture in a pelvic fragility fracture related to a prior bladder mesh sling. This case highlights the importance of obtaining a thorough surgical history when treating pelvic injuries.
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Affiliation(s)
- Ian M Meshay
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Jordan B Robbins
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Jared Wainwright
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Joseph Sonstein
- Division of Urology, The University of Texas Medical Branch, Galveston, Texas
| | - Joshua Person
- Division of Trauma and Acute Care Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - John C Hagedorn
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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Chen K, Bhattacharjee S, Seidel H, Dillman DB, Strelzow JA. Association of Pelvic Trauma With Rates of Cesarean Section, Sexual Dysfunction, and Genitourinary Dysfunction in a National Database. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202304000-00006. [PMID: 37036931 PMCID: PMC10090791 DOI: 10.5435/jaaosglobal-d-22-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/31/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Pelvic fractures are severe injuries that can drastically affect a woman's quality of life through sexual dysfunction (SD), genitourinary dysfunction (GD), and increasing the potential need for future cesarean section (C-section). Limited research has captured long-term outcomes after pelvic fractures in women of childbearing age. This study aimed to determine the association between pelvic fractures and rates of C-section, SD, and GD. METHODS All women of childbearing age who sustained a pelvic fracture were identified in a national insurance database. A comparison group of patients with lower extremity long-bone fractures was selected. Patients who gave birth after injury were additionally identified. A minimum of 5 years of follow-up was required for inclusion. Rates of C-section, SD, and GD were compared between cohorts. Multivariate logistic regression analysis was conducted with the inclusion of diabetes, tobacco, hypertension, obesity, and advanced maternal age. RESULTS A total of 6,174 patients with pelvic fracture and 27,154 control fracture patients were identified. 434 patients with pelvic fracture (7.0%) and 1,258 control fracture patients (4.6%) gave birth after fracture. Patients with pelvic fracture had a significantly higher rate of C-section (50.0% versus 38.8%, P < 0.001), SD diagnosis (10.9% versus 8.8%, P < 0.001), and urinary retention diagnosis (3.5% versus 2.8%, P < 0.001). No significant difference in global GD diagnosis was identified. Multivariate analyses showed that pelvic fracture was associated with C-section (odds ratio [OR]: 1.78; 95% confidence interval [95% CI]: 1.42 to 2.23, P < 0.001), SD diagnosis (OR: 1.23; 95% CI: 1.12 to 1.35, P < 0.001), and urinary retention diagnosis (OR: 1.35; 95% CI: 1.15 to 1.57, P < 0.001). DISCUSSION Pelvic fractures confer an intrinsic level of risk of C-section, SD, and urinary retention that is elevated beyond what would be expected from a traumatic lower extremity injury alone. Treating orthopaedic surgeons should actively counsel women regarding increased risks, openly discuss postinjury sequelae, and coordinate interspecialty care beyond initial treatment of acute trauma.
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Affiliation(s)
- Kevin Chen
- From the Pritzker School of Medicine at the University of Chicago, Chicago, IL (Mr. Chen, Dr. Bhattacharjee, and Mr. Seidel); and the Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL (Dr. Dillman and Dr. Strelzow)
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Rovere G, Smakaj A, Perna A, De Mauro D, Are L, Meccariello L, Fidanza A, Erasmo R, Falez F, Maccauro G, Liuzza F. Correlation between traumatic pelvic ring injuries and sexual dysfunctions: a multicentric retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1407-1414. [PMID: 36930257 DOI: 10.1007/s00264-023-05767-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Among the functional impairments associated with pelvic ring injuries (PRI), sexual dysfunction (SD) is a common clinical issue. The aim of this study is to investigate correlations between traumatic PRI, genitourinary, and sexual dysfunctions, for a proper multidisciplinary treatment. METHODS We performed an observational, multicentric study, from January 2020 to 2022. We conducted a follow-up after surgery at three, six, 12, and 24 months by measuring the Female Sexual Functioning Index (FSFI), the International Index of Erectile Function (IIEF), the Arizona Sexual Experience Scale (ASEX), the Majeed Score, and the SF-12. Descriptive statistics was conducted on T-test, Whelc's test, and one-way ANOVA which were performed when appropriate. RESULTS A total of 76 patients (mean age 42.17 ± 15 years) were included in the study and allocated into three groups (A, B, and C). Tile A group revealed good sexual outcomes, similar to that of healthy patients. Tile B group demonstrated worsen SD than the previous group. In Tile C group, there was a longer average duration of the orthopaedic surgery when compared to group B. However, in terms of SDs, statistical significance could not be demonstrated between groups C and B. CONCLUSIONS We observed a progressive spontaneous recovery of sexual function, corresponding to each PRI group. Moreover, men classified as B2 had milder SDs than B1 male patients.
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Affiliation(s)
- Giuseppe Rovere
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Orthopaedics and Traumatology, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Domenico De Mauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Are
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Meccariello
- Department Orthopaedics and Traumatology, AORN San Pio, Benevento, Italy
| | - Andrea Fidanza
- Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Rocco Erasmo
- Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Giulio Maccauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Liuzza
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
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Romoli S, Petrella L, Becattini E, Pisano A, Wembagher GC, De Biase P. Treatment of unstable spinopelvic fractures: outcome of three surgical techniques-a retrospective single-center case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:93-100. [PMID: 35964267 DOI: 10.1007/s00586-022-07330-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/16/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of our retrospective study is to analyze how spinopelvic dissociations (SPDs) were treated in a single center trying to better understand how to improve surgical and non-surgical options. METHODS Twenty patients of a single center surgically treated for SPDs between 2013 and 2021 were retrospectively included in this study. Three surgical techniques have been used: modified triangular stabilization, triangular stabilization and double iliac screws stabilization. Follow-up was assessed for up to 11.6 ± 9.9 months through ODI, MRS, NRS, IIEF or FSFI, a CT scan and whole spine X-ray examination. RESULTS Twenty patients were admitted to our ER for traumatic spinopelvic dissociation. Surgical treatment for spinopelvic dissociation has been performed on average 11.5 ± 6.7 days after the trauma event. Eighteen fractures were C3 type and two C2 types. Neurological examination showed nerve root injury (N2) in 5 patients, incomplete spinal cord injury (N3) in 4 patients and cauda equina syndrome in two patients (N4). In case of neurologic deficits, routinary nerve decompression was performed. Three different surgical techniques have been used: 8 triangular fixations (Group 1), 6 modified triangular stabilization (Group 2) and 6 double iliac screws triangular fixation (Group 3). CONCLUSION In patients with post-traumatic neurological deficit, decompression surgery and fracture reduction seem to be associated with clinical improvement; however, sexual disorders seem to be less responsive to the treatment. Some open stabilization techniques, such as the double iliac screw, could help in restoring the sagittal balance in case of severe deformities.
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Affiliation(s)
- S Romoli
- Spine Surgery Unit, Careggi University Hospital, Largo Palagi 1, 50137, Florence, Italy
| | - L Petrella
- Spine Surgery Unit, Careggi University Hospital, Largo Palagi 1, 50137, Florence, Italy
| | - Eleonora Becattini
- Spine Surgery Unit, Careggi University Hospital, Largo Palagi 1, 50137, Florence, Italy.
| | - A Pisano
- Spine Surgery Unit, Careggi University Hospital, Largo Palagi 1, 50137, Florence, Italy
| | - G C Wembagher
- Spine Surgery Unit, Careggi University Hospital, Largo Palagi 1, 50137, Florence, Italy
| | - P De Biase
- Traumatology and General Orthopedic Surgery, Careggi University Hospital, Florence, Italy
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Lefaivre KA, Roffey DM, Guy P, O'Brien PJ, Broekhuyse HM. Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture. J Orthop Trauma 2022; 36:118-123. [PMID: 34407035 DOI: 10.1097/bot.0000000000002247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Darren M Roffey
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2687-2697. [PMID: 34378143 PMCID: PMC8514382 DOI: 10.1007/s00264-021-05153-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
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.
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Testa EJ, Alam SM, Kahan LG, Ziegler O, DeFroda S. Genitourinary complications in orthopaedic surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:201-210. [PMID: 33782736 DOI: 10.1007/s00590-021-02944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Genitourinary complications following orthopaedic intervention are uncommon but well-described occurrences and exist on a spectrum of severity. These complications vary depending on the anatomic location and surgical approach, with surgery of the spine, hip, and pelvis of particular concern. Injuries to the urinary tract may present acutely with urinary retention or hematuria. However, they often have a delayed presentation with severe complications such as urinary fistula and recurrent infection. Delayed presentations may place the onus of timely and proper diagnosis on the orthopaedic provider, who may serve as the patient's primary source of long-term follow-up. Detailed knowledge of anatomy and at-risk structures is key to both preventing and identifying injury. Although iatrogenic injury is not always avoidable, early identification can help to facilitate timely evaluation and management to prevent long-term complications such as bladder dysfunction, obstructive renal injury, sexual dysfunction, and chronic pain. Keywords: urologic injury, bladder injury, genitourinary injury, hip arthroplasty, pelvic ring injuries, spine surgery.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Syed M Alam
- Department of Urology, University of Kansas Health System, Kansas City, KS, United States of America
| | - Lindsey G Kahan
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Olivia Ziegler
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Steven DeFroda
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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Watkins RJ, Hsu JM. The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures. Front Surg 2020; 7:58. [PMID: 32984402 PMCID: PMC7493634 DOI: 10.3389/fsurg.2020.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.
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Affiliation(s)
| | - Jeremy M Hsu
- Trauma Service, Westmead Hospital, Westmead, NSW, Australia.,Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
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Spontaneous Urethral Laceration in a Patient Experiencing Acute Ulcerative Colitis Flare. Case Rep Urol 2020; 2020:9285071. [PMID: 32089945 PMCID: PMC7025027 DOI: 10.1155/2020/9285071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/19/2020] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
Spontaneous urethral laceration in the female without associated external trauma is an exceedingly rare phenomenon. Most cases are related to childbirth or the presence of a concomitant pelvic fracture or penetrating injury. Herein, we present a novel case of spontaneous urethral laceration in a female which happened to occur during an acute flare of her previously diagnosed ulcerative colitis. The diagnosis of spontaneous urethral laceration is rare, and underlying etiology is often uncertain.
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Stern N, Pignanelli M, Welk B. The management of an extraperitoneal bladder injury associated with a pelvic fracture. Can Urol Assoc J 2019; 13:S56-S60. [PMID: 31194928 DOI: 10.5489/cuaj.5930] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Noah Stern
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Micheal Pignanelli
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Blayne Welk
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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Duramaz A, Ilter MH, Yıldız Ş, Edipoğlu E, İpek C, Bilgili MG. The relationship between injury mechanism and sexual dysfunction in surgically treated pelvic fractures. Eur J Trauma Emerg Surg 2019; 46:807-816. [PMID: 30617402 DOI: 10.1007/s00068-018-01067-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Mehmet Hakan Ilter
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Şükrü Yıldız
- Department of Gynecology and Obstetrics, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Erdem Edipoğlu
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Cem İpek
- Department of Urology, Kanuni Sultan Süleyman Education and Research Hospital, Atakent St. Number 46, 34307, Küçükçekmece, Istanbul, Turkey
| | - Mustafa Gökhan Bilgili
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
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Abstract
The most common cause of post-traumatic pelvic asymmetry is, by far, initial nonoperative treatment. Open reduction and internal fixation of unstable pelvic fractures are recommended to avoid pelvic nonunion or subsequent structural deformities. The most common symptom is pelvic pain. Pelvic instability is another symptom, as well as persistent urogenital problems and neurological sequelae. Preoperative evaluation of these patients requires careful clinical and functional assessment, in addition to a complete radiological study. Surgical treatment of pelvic fracture nonunions is technically demanding and has potentially serious complications. We have developed a new classification that modifies and completes Mears and Velyvis’s classification in which we highlight two types of post-traumatic sequelae with different clinical conditions and whose basic differentiating element is whether pelvic deformity is present or not. Based on this classification, we have established our strategy of surgical treatment.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170069.
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Affiliation(s)
- Pedro Cano-Luís
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain
| | | | - Pablo Andrés-Cano
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain
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Late reconstruction of severe open-book deformities of the pelvis - tips and tricks. INTERNATIONAL ORTHOPAEDICS 2017; 41:1777-1784. [PMID: 28681229 DOI: 10.1007/s00264-017-3549-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The primary goal of treatment for open book pelvic injuries after high-energy trauma is to control haemorrhage and to close the pelvic ring anatomically. Less commonly, patients may present late with malunion or non-union. METHODS We reviewed five operatively treated patients with delayed severe open book deformities who had a diastasis of more than 6 cm. We describe the pre-operative workup, surgical strategy and challenges experienced. They specifically include: extensive scar and contracture formation, malunion, urogenital prolapse and difficult reduction of vertical shear element. A 5 to 15-point clinical scoring system based on quality of life regarding pain, ambulation, social function, continence control and presence of prolapse is proposed. RESULTS One elderly patient had early mortality after surgery. The other four patients had quality of life improvement by 3 to 5 points after one year. Correction is often clinically successful despite technical challenges and unpredictable radiological results. CONCLUSION External fixator and the C-clamp are good reduction tools. Powerful implants should be used and fixation of the posterior ring is mandatory. Staged urogenital and pelvic floor reconstruction is recommended before bony reconstruction to minimize the risk of wound contamination. Patients receiving this complex procedure have a good chance for improvement in pain and functional status.
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