Fri., 10/14/11 Pelvis & Spine, Paper #47, 10:57 am OTA-2011
Quality of Life and Sexual Function Following Traumatic Pelvic Fracture
Katherine F. Harvey-Kelly, MD1; Nikolaos K. Kanakaris, MD2; Oghor Opakponovwe, MD2; Mudussar Ahmad, MD2; Robert M. West, MD3; Peter V. Giannoudis, MD1;
1Academic Dept. of Trauma & Orthopaedics, School of Medicine, University of Leeds,
Leeds, United Kingdom;
2Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom;
3Dept. of Biostatics, University of Leeds, Leeds, United Kingdom
Purpose: Pelvic fractures are indicators of severe trauma and high-energy absorption. They are associated with multiple local or distant concomitant injuries, which explain their high mortality and morbidity. The aim of this study is to investigate the late sequelae of traumatic pelvic fractures (PFX), focusing on quality of life and sexual-function.
Methods: From a database of prospectively documented data, patients who had suffered a PFX and had been treated operatively in our institution from January 2008 to January 2009 were eligible to participate in this study. Ethics committee approval was obtained. Exclusion criteria were patients less than a year postinjury, pathologic fractures, patients <18 or >65 years of age, and patients with comorbidities linked to sexual dysfunction. Demographics, injury mechanisms, fracture patterns (Young-Burgess classification), injury severity score (abbreviated injury scale [AIS]/05-ISS), urogenital injuries, and clinical outcome were recorded and analyzed. Health-related quality of life was assessed using the EuroQol 5D (EQ-5D) and sexual function using the international index of erectile function and the female sexual function index. Patients were asked to fill in the questionnaires twice (once documenting their state prior to their injury and the second time recording their state after the injury). The minimum follow-up was 12 months (range, 12-30 months).
Results: Out of 85 patients that met the inclusion criteria, 67 patients (24 females) with a mean age of 44 years (range, 19-65 years) consented to participate in this study. Their mean ISS was 25 (range, 9-58), while 5 (7.4%) had isolated PFX. There was shown to be a significant decrease in quality of life (P <0.0001) and sexual function (P <0.0001). The decrease was significant in all 5 EQ-5D domains with mobility, usual activities, and pain as the most significantly affected (P <0.0001). 50.7% (34) patients reported a significant (P <0.0001) decrease in their postinjury sexual function score (55.5% males, 47.8% females). Linear regression showed urinary tract injury to be an independent risk factor for sexual dysfunction (P <0.0001), while a Mann-Whitney U test identified that the PFX severity (fracture types VS-AP3-LC3-CMI vs LC1-LC2-AP1-AP2-ILBL) correlated to sexual dysfunction (P = 0.0463).
Conclusion: Both genders, irrespective of age subgroups, suffering a PFX severe enough to undergo surgery are at risk of a significant decrease of their quality of life and sexual-function. The presence of certain fracture types and urinary tract injuries can be used as predictors of late morbidity and early multidisciplinary management.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.