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AAOS Now

Published 3/25/2022
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Brandon May

Pelvic Fractures Increase Risk of C-section, Sexual Dysfunction, and Urinary Retention

A study suggests that pelvic fractures in women of childbearing age are associated with increased risks of Cesarean section (C-section), sexual dysfunction, and urinary retention. Findings from this study are to be presented by Kevin Chen, medical student at the Pritzker School of Medicine at the University of Chicago.

Given the findings, Mr. Chen and colleagues indicate that orthopaedic traumatologists should recognize pelvic fracture as a significant risk factor for long-term reproductive, sexual, and genitourinary issues. “We hope that our study can not only inform clinicians of the impact of pelvic fracture on these long-term outcomes, but also encourage active counseling and coordinated interspecialty care for these women beyond their initial treatment for acute trauma,” the researchers wrote.

According to the authors, little research to date has described long-term outcomes among women of childbearing age who have experienced a pelvic fracture. Previous studies, they added, have had several limitations, such as small sample sizes, single-center design, and lack of control groups. Given that a pelvic fracture can impact a woman’s quality of life via sexual dysfunction, genitourinary dysfunction, and potential future need for a C-section, there is an undeniable need to improve understanding of post-fracture outcomes in this population.

The investigators used a large national insurance claims database to identify women aged 15 to 49 years who had sustained a pelvic fracture between 2005 and 2014. The database consists of 51 million records of deidentified orthopaedic patients. A population of patients with lower-extremity fractures (femur/tibia) was used as a control population. In total, the study included 6,174 patients with pelvic fractures and 27,154 control fracture patients.

Within a five-year follow-up period from the injury, a total of 434 patient (7.0 percent) with a pelvic fracture and 1,258 of control patients (4.6 percent) had 444 and 1,267 deliveries, respectively. None of the patients had previously had a C-section, and all patients were required to have five years’ worth of follow-up data in the database.

The investigators compared the groups for rates of C-section, sexual dysfunction, and genitourinary dysfunction. Significant variables associated with those outcomes in a univariate analysis were applied to multivariate logistic regressions to identify an association between pelvic fracture and C-section and sexual or genitourinary dysfunction within the five-year follow-up study period.

During follow-up, women who experienced a pelvic fracture had a significantly higher rate of C-section compared with controls (50.0 percent versus 38.8 percent, respectively, P <0.001). additionally, although the rate of sexual dysfunction was significantly higher in the pelvic fracture cohort (10.9 percent versus 8.8 percent,>P <0.001), no difference was found between the groups in terms of the rate of genitourinary dysfunction (11.9 percent versus 11.2 percent,>P = 0.11). A subset analysis that focused on individual genitourinary dysfunction diagnoses found that patients with a pelvic fracture had a significantly higher rate of urinary retention (3.5 percent versus 2.8 percent, P = 0.004) when compared with the control group.

In the multivariable analyses, researchers found that pelvic fracture was independently associated with C-section (odds ratio [OR] = 1.78, P <0.001), sexual dysfunction diagnosis (or="1.23,">P <0.001), and urinary retention diagnosis (or="1.35,">P <0.001).>

The investigators noted that by using data from a national database in the study, they lacked access to charts or radiographs to distinguish among different fracture types, severity of injuries, residual deformities, and fixation methods. In addition, the researchers wrote that they were unable to identify the exact cause and effect of pelvic trauma on C-section, sexual dysfunction, and retention outcomes, highlighting that the findings only demonstrate a correlation between the variables.

The study will be presented as Paper 535 on Friday at 8:30 a.m. in Room S406a.

Dr. Chen’s coauthors of “Association of Pelvic Trauma with Rates of Cesarean Section, Sexual Dysfunction, and Genitourinary Dysfunction in a National Database” are Sarah Bhattacharjee, BSE; Henry Seidel, BS; and Jason Strelzow, MD.

Brandon May is a freelance writer for AAOS Now.