Review Question - QID 219516

This 37-year-old obese male sustained an anterior-posterior compression (APC) II pelvic ring fracture. The most common complication seen with this fracture is sexual dysfunction (Answer 3).

Pelvic ring injuries are uncommon, high-energy fractures that occur secondary to blunt trauma. Due to the high-energy nature of the fracture and the innominate bone's location with respect to the abdominal viscera, there are often concomitant injuries, most commonly involving the chest wall, urogenital organs, or nerves. Beyond the acute period, a number of patients experience lasting effects, namely sexual dysfunction, persistent pain, and ambulatory dysfunction. Sexual dysfunction in particular, with a reported rate ranging from 35-56%, is more common in females, APC injuries, and in those requiring fixation of the symphysis, and can have long-lasting effects on the overall well-being of the patient.

Lefaivre et al. performed a prospective cohort study of 113 patients sustaining pelvic ring fractures requiring surgical fixation and examined urinary and sexual functioning following fixation. The authors noted an overall worsening trend in overall urinary function over time in men, while women did not see a significant change in overall function. Both genders experienced significant decreases in sexual function up to five years following surgery. Overall, the authors conclude urinary and sexual dysfunction have a significant impact on overall well-being and stress the importance of multidisciplinary teams when caring for these complex patients.

Vallier et al. performed a retrospective review of 187 females who sustained pelvic ring fractures and examined the rate of sexual dysfunction following their injury, comparing them to an uninjured control group. Approximately 56% reported dyspareunia following their injury, which led to less frequent intercourse in 75%. Initial fracture pattern (APC injuries), disruption of the pubic symphysis, plate fixation of the symphysis, and malunion > 5 mm were all found to be risk factors for sexual dysfunction. The authors conclude sexual dysfunction is a common occurrence in women suffering pelvic ring fractures and emphasize adequate reduction in those necessitating ORIF.

Figure A demonstrates an AP pelvis radiograph showing widening of the symphysis and right sacroiliac joint. Figure B is an axial CT image demonstrating widening of the right sacroiliac joint. Figure C shows post-operative fixation of the aforementioned pelvic ring injury.

Incorrect Answers:
Answer 1, 2, 4, 5: while these are known complications, they do not occur at the frequency of sexual dysfunction, particularly with APC fractures.