Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

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.

Bone Fracture Patterns and Distributions according to Trauma Energy

“…Patients with anterior and posterior compression-type and vertical shear-type fracture patterns reported a higher incidence and severity of sexual dysfunction. However, only a weak association was found between genitourinary injuries, the occurrence and severity of sexual dysfunction, and the association between surgical treatment and sexual dysfunction [34].…”

Interprosthetic and interimplant femoral fractures: is bone strut allograft augmentation with ORIF a validity alternative solution in elderly?

“…15 According to our modern experience, lateral plate and medial strut allograft is the best choice to treat the perimplants failure 16 and periprosthetic femoral fracture. [16][17][18] The cortical strut only allografts confer stability to the fracture site, and they can incorporate and ultimately increase the femoral bone stock. 19 They also "lengthen" the working length of the screws.…”

“…Our studies have suggested that cortical struts predictably unite, remodel, mature and not breakage's risk. [16][17][18][19] To obtain the maximum stability of the metal-biological construct the osteosynthesis with screws should always be used (Figure 1 and Figure 2) because the use of metal cerclage cables can lead to implant failures and subsequent revisions. 22,24 Other authors suggested Total femur replacements or a megaprosthesis are typically reserved for patients with lim-ited bone stock and loose implants or in the situation of multiple failed fracture fixation or persistent fracture nonunion, revision to a megaprosthesis may provide a route to definitive treatment.…”

Identification of safe channels for screws in the anterior pelvic ring fixation system

“…Screw penetration of the bone cortex may damage the lumbosacral plexus nerves, internal iliac vessels, genitourinary system and gastrointestinal system, and due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system and gastrointestinal system, severe consequences of massive hemorrhage may lead to death [ 5 ]. Injury of lumbosacral plexus nerves and genitourinary system may lead to sexual dysfunctions with important influence on quality of life, especially in young patients [ 6 ].…”

“…With the development of orthopedic navigation technology, some scholars have applied navigation technology to insert fixation screws in pelvic fractures [ 7 ]. Ciolli et al inserted percutaneous screws of the anterior ring internal fixator system by navigation system based on 3D fluoroscopic images, and the conclusion is that the use of the O-arm deals with great precision in the positioning of the screw and reduced surgical times with excellent clinical results in patients [ 6 ]. However, navigation technology requires special intraoperative imaging system, and surgery requires longer learning curves.…”