Session VII - Pelvis
The Effects of Pelvic Ring Injury on Sexual and Reproductive Function in Women
Purpose: Previous studies have reported a negative effect of pelvic trauma on genitourinary and reproductive function of women. Dyspareunia and Cesarean section rates correlate with initial fracture displacement. However, the pattern and severity of injury and final fracture alignment have not been studied. The purpose of this project was to evaluate sexual dysfunction and reproductive problems, including rates of subsequent Cesarean section, in women with pelvic ring injury.
Methods: We retrospectively reviewed the medical records and radiographs of 96 women under the age of 55 years (mean, 33 years) with pelvic ring injury. The mechanism of injury was a motor vehicle accident (n = 71), pedestrian vs. motor vehicle (n = 13), fall (n = 6), motorcycle accident (n = 4), or other (n = 2). The OTA classification included 46 B-type (61-B1: n = 11, B2: n = 31, B3: n = 4) and 43 C-type (61-C1: n = 19, C2: n = 13, C3: n = 11) fractures. Two patients had open fractures, and 8 had associated genitourinary injury, with 7 bladder ruptures and 1 vaginal laceration. 42 patients were treated operatively and 54 patients nonoperatively. Surgical treatment was entirely percutaneous in 19: iliosacral screws (n = 6), external fixation (n = 3), or both (n = 10). Open reduction and internal fixation (ORIF) was performed for the pubis symphysis (n = 15), sacroiliac joint (n = 3), and posterior ileum (n = 6). Musculoskeletal Function Assessment (MFA), obstetrical history, and sexual function questionnaires were completed for 46 patients with a minimum of 12 months and a mean of 48 months of follow-up.
Results: 19 (41%) reported pain with intercourse. This group had mean MFA scores of 50.0, vs. 21.6 in patients without pain during intercourse (P = 0.0001). 62% of patients with B fractures and 39% of patients with C fractures had pain with intercourse (P = 0.15), and the mean MFA scores for B and C fractures were 40.5 and 30.6, respectively. With the numbers available, the presence of sacral fracture or sacroiliac injury and the amount of initial or final displacement in these areas (0 to 4 mm, 5 mm, 10 mm), and the type of posterior ring treatment were not associated with dyspareunia or with MFA scores. 21 C fractures (78%) and two B fractures (11%) were treated surgically. Mean MFA scores were 37.0 after surgery and 31.4 without surgery. 25% of patients with a symphyseal disruption had pain with intercourse and 33% of them had MFA scores >20. Nine patients had associated femur fractures, and 7 patients had associated tibia fractures. Twelve of them had pain during intercourse (P = 0.02). Fifteen patients had postinjury pregnancies, and 7 resulted in Cesarean section. Five of the 7 patients with Cesarean section had ORIF of their anterior pelvic ring. Four patients had uncomplicated vaginal deliveries, and all of their pelvic injuries had been treated nonoperatively (P = 0.02).
Conclusions/Significance: Dyspareunia and poor functional outcome scores are common in women who have had a pelvic ring fracture. Partial posterior injuries (B fractures) were associated with more pain during intercourse and worse MFA scores. Additional data may define a relationship between the type of treatment for B fractures and pain with intercourse. Disruption of the pubic symphysis was associated with dyspareunia, MFA scores >20, and Cesarean section. Cesarean section occurred more often in patients who had surgical treatment of their pelvic fractures, and the reason for this is unclear. Further study is necessary to determine recommendations for pregnant women with a history of pelvic ring injury.