Traumatic Pelvic Fractures Research Articles

Clinical and radiographic predictors for angiography in pelvic trauma: An analysis of 1703 patients

IntroductionPatients who present with hemorrhage from pelvic fractures have an increased risk of mortality with prolonged time to intervention. Identifying risk factors associated with hemorrhage can expedite treatment. In this study we explore clinical and radiographic predictors for angiography in trauma patients with pelvic fractures. MethodRetrospective, single-center review between 2009 and 2019 at a level 1 trauma center of all trauma patients with pelvic fractures. We excluded patients who died prior to arrival or in the trauma bay who did not undergo computed tomography (“CT”). Finalized attending descriptions of CT findings were reviewed, including size of hematomas, and presence of extravasation. Chi-square, Mann-Whitney U and multi-variate regressions were performed. ResultsWe analyzed 1,703 trauma patients with pelvic fractures. Most common mechanisms of injury included MVC (45 %), fall (27 %) and motorcycle accident (12 %). 48 % (819/1703) of patients had pelvic hematomas on CT scan. 17 %(138/819) of patients with a hematoma also had evidence of extravasation. Significant predictors for extravasation on CT included large hematoma on CT, AIS extremity ≥2, binder placement, increased ISS, HR, and decreased GCS and SBP (p < 0.005). Significant predictors for angiography were similar, including AIS extremity ≥2, binder placement, presence of moderate and large hematoma and active extravasation on CT (p < 0.01). Stepwise logistic regression model incorporated ISS, HR, AIS extremity score, binder placement, and contrast extravasation with an AUC = 0.9345. ConclusionIn this large retrospective review of traumatic pelvic fractures, specific clinical and radiographic factors were significantly associated with pelvic hematomas, extravasation and/or need for angiography. Future collaborative work with orthopedics and interventional radiology is planned to better triage pelvic fracture patients and identify those at risk for bleeding that require earlier intervention.

Impact Of Introducing 3D Printing-Assisted Surgery Into Clinical Practice For Traumatic Pelvic And Acetabular Fractures

BackgroundGiven the novelty of three-dimensional (3D) printing-assisted fracture surgery in orthopaedics, surgeon familiarity is limited and learning curve is high. As such, it is unclear how the introduction of 3D printing into clinical practice for pelvic and acetabular fracture surgery would impact perioperative outcomes. The aim of this study was to determine the impact of introducing 3D printing-assisted surgery on perioperative outcomes for traumatic pelvic and acetabular fractures. MethodsWe retrospectively identified consecutive patients who underwent surgical fixation of traumatic pelvic and acetabular fractures from 2018 to 2022 at a single tertiary hospital. The patients included in the study were divided into two groups: (1) 3D printing-assisted surgery and (2) conventional surgery. Baseline demographics and perioperative outcomes of total surgical duration, estimated blood loss, blood transfusion, number fluoroscopy images, fluoroscopy duration and postoperative disposition were recorded and compared between the two groups. ResultsIn total, 26 patients were included in the present study, with 3D printing-assisted surgery being used in 34.6% (n=9) of cases. There were no significant differences in baseline demographics or fracture type between the 3D printing group and conventional group. As compared to patients who underwent conventional surgery, those that underwent 3D printing-assisted surgery had, on average, shorter surgical duration (299.8±88.2 vs 309.1±143.1 mins), lesser estimated blood loss (706.3±330.0 vs 800.0±584.2 ml), lower transfusion rates (50.0% vs 52.9%), lower number of intraoperative fluoroscopy images (62.8±74.5 vs 71.6±47.9 images) and shorter fluoroscopy duration (235.0±79.2 vs 242.3±83.5 mins), although statistical significance was not achieved. None of the patients in the present study developed surgical complications postoperatively. ConclusionThe introduction of 3D printing-assisted surgery in clinical practice for pelvic and acetabular fractures is a safe and viable adjunct in pelvic and acetabular surgery, achieving comparable perioperative outcomes in the initial phase.

Extraperitoneal pelvic packing versus angiographic embolization for hemodynamically unstable pelvic fractures: a retrospective single-center analysis.

To retrospectively analyze the clinical data and treatment procedures of angiographic embolization (AE) and extraperitoneal pelvic packing (EPP) for traumatic pelvic fractures in our center for the purpose of providing recommendations on the selection of treatment protocols. We analyzed 110 patients with traumatic pelvic fractures treated with AE and EPP from January 2015 to May 2023. The patients were divided into the AE group (69 men, 41 women) and the EPP group (20 men, 12 women). The primary outcomes were the mortality rate and incidence of complications. The mortality rate was slightly lower in the AE than EPP group (7.3% vs. 9.4%). The overall blood transfusion volume was lower and the length of hospital stay was shorter in the AE than EPP group (7.79 ± 12.04 vs. 9.14 ± 14.21 units and 20.48 ± 11.32 vs. 22.14 ± 10.47 days). Both AE and EPP have good treatment effects. AE is preferred for patients in stable condition with severe hemorrhage. This study suggests that EPP should be the primary treatment and that AE should serve as a complementary treatment for critical patients.

Outcomes of supra-acetabular pin placement with and without fluoroscopic assisted: a prospective randomized controlled trial.

To compare outcomes of fluoroscopic-assisted supra-acetabular pin placement percutaneous technique versus the open technique in traumatic pelvic fractures. Prospective randomized controlled trial was performed at Maharat Nakhon ratchasima hospital from January 2020 to March 2021. Time, size of wound, and position of supra-acetabular pin were recorded intraoperatively. Pin positions were confirmed and measured by postoperative CT scan. Complications such as cortex penetration, infection, hip joint violation, and lateral thigh numbness were recorded at 2weeks postoperatively. Twenty patients (40 hemipelvis) were randomized to fluoroscopic-assisted and non-fluoroscopic groups. Time taken for supra-acetabular pin placement for fluoroscopic-assisted and non-fluoroscopic-assisted groups was 211 and 522s, respectively (P value < 0.001). Average wound size was 2.81cm in the fluoroscopic-assisted group and 6.01cm in the non-fluoroscopic-assisted group (P value < 0.001). Overall complications were similar in both groups with higher infection rates in the fluoroscopic-assisted group (5 and 0%, respectively). Pelvic fracture is a life-threatening condition, which requires emergency pelvic stabilization. This study examined operative times for supra-acetabular placement and complication rates. The results show shorter operative times for the non-fluoroscopic-assisted technique without significant differences in complication rates. Non-fluoroscopic technique greatly reduced operative times for supra-acetabular pin placement with comparable safety to the fluoroscopic-assisted technique.

Pediatric Pelvic and Acetabular Fractures: Discerning Severity by Classification and Clinical Management.

Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population. Pediatric patients, once stabilized, are often transferred for these injuries. We evaluated which commonly used systems correlate with clinical management in pediatric patients, including transfer patterns based on injury severity. A retrospective review of patients aged 1 to 15 treated for traumatic pelvic or acetabular fractures over a 10-year period at an academic level I Pediatric Trauma Center reviewed demographic, radiographic, and clinical data. A total of 188 pediatric patients (average age 10.1y) were included. Increasing injury severity based on classification Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA P <0.001; Young and Burgess P <0.001; Torode/Zieg P <0.001), increasing Injury Severity Score ( P =0.0017), and decreasing hemoglobin levels ( P =0.0144) were significantly associated with operative management. Injury characteristics did not differ between patients who were transferred versus patients who were brought in directly from the field. Air transport was significantly associated with surgical treatment, pediatric intensive care unit admission, polytrauma, and Torode/Zieg classification ( P =0.036, <0.0001, 0.0297, 0.0003, respectively). Although not fully descriptive of skeletally immature fracture patterns, the AO/OTA and Young and Burgess classification systems adequately assess the severity of pelvic rings and injuries in pediatric patients and predict management patterns. The Torode and Zieg classification also predicts management. In a large cohort, air transport was significantly associated with surgical treatment, need for pediatric intensive care unit stay, the presence of an additional injury, and instability in the Torode and Zieg classification. These findings suggest that air transfers are being utilized to expedite advanced-level care in more severe injuries. Further studies with long-term follow-up are required to assess the clinical outcomes of both nonoperatively and operatively treated pediatric pelvic fractures and to guide both triage and treatment decisions for these rare but severe injuries. Level III.

Preliminary data on the neurophysiological evaluation of male sexual dysfunction in patients with pelvic ring fractures: a multicenter retrospective study.

Traumatic pelvic ring fractures include several comorbidities due to the close anatomical relationship between the skeletal system, pelvic organs, and neurovascular structures. In this retrospective multicenter study, we evaluated patients complaining of sexual dysfunction following pelvic ring fractures, assessed through different neuro-physiological examinations. Patients were enrolled one year after the injury according to their reported ASEX scores and evaluated on the basis of the Tile's type of pelvic fracture. Lower limb and sacral somatosensory evoked potentials, pelvic floor electromyography, bulbocavernosus reflex and pelvic floor motor evoked potentials were recorded, according to the neurophysiological indications. A total of 14 male patients (mean age 50.4; 8 subjects Tile-type B and 6 Tile-type C) were enrolled. The ages between the Tile B group and the Tile C group of patients were not significantly different (p=0.187), while the ASEX scores were significantly different (p=0.014). In 57% of patients (n=8), no alterations in nerve conduction and/or pelvic floor neuromuscular responses were found. In 6 patients, electromyographic signs of denervation were revealed (2 patients), and alterations of the sacral efferent nerve component were detected in 4 patients. Sexual dysfunctions after a traumatic pelvic ring fracture are more common in Tile-type B. Our preliminary data did not reveal a significant association with neurogenic aetiology. Other causes could explain the complaining impairments.

Ogilvie Syndrome in Patients With Traumatic Pelvic and/or Acetabular Fractures: A Retrospective Cohort Study.

To assess the incidence, risk factors, and clinical outcomes of Ogilvie syndrome (OS) in patients with pelvic and/or acetabular fractures. Retrospective cohort study. Level 1 trauma center. One thousand sixty patients with pelvic and/or acetabular fractures treated at Rigshospitalet, Copenhagen, between 2009 and 2020. Interventions comprised the treatment of pelvic and/or acetabular fractures with emergency external and/or internal fixation. Outcomes included diagnosis of OS, perioperative complications, ICU stay and length, length of admission, and mortality. We identified 1060 patients with pelvic and/or acetabular fractures. Of these, 25 patients were diagnosed with OS perioperatively, corresponding to incidences of 1.6%, 2.7%, and 2.6% for acetabular, pelvic, and combined fractures, respectively. Risk factors included congestive heart failure, diabetes, concomitant traumatic lesions, head trauma, fractures of the cranial vault and/or basal skull, retroperitoneal hematomas and spinal cord injuries, and emergency internal fixation and extraperitoneal packing. Six (24%) patients underwent laparotomy, and all patients had ischemia or perforation of the cecum for which right hemicolectomy was performed. Ogilvie syndrome was associated with a significant increase in nosocomial infections, sepsis, pulmonary embolism, ICU stay, and prolonged hospital admission. Ogilvie syndrome in patients with pelvic and/or acetabular fractures is associated with increased risk of perioperative complications and prolonged hospital and ICU stays, resulting in an increased risk of morbidity and mortality. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Estudio observacional retrospectivo correlacionando las fracturas traumáticas de pelvis y sus lesiones asociadas según la clasificación de Tile

IntroductionPelvic fractures due to high energy trauma present a high risk of associated injuries that compromise the functional and vital prognosis of the patients. The objective of this study was to analyze the relationship between traumatic pelvic fractures and their associated injuries according to the Tile classification. MethodsRetrospective observational study of patients who suffered traumatic pelvic fractures (Type A, B or C of the Tile classification) with concomitant associated injuries, analyzing hemoglobin levels, between 6/2013 and 1/2016. ResultsA total of 42 patients were included; of those 69% (n=29) were males, mean age was 48 years. 45% (n=19) suffered traffic accidents and 26.2% (n=11) falls. There was a different proportion in pelvic injuries: Tile A (n=15, 35.7%), B (n=20, 47.6%), and C (n=7, 16.6%) of cases. 54.8% (n=23) underwent surgery, 21.4% (n=9) needed temporary or definitive external fixation. Significant differences were found between Tile A type and scapula fractures (P=.032), and Tile B with sacral fractures (P=.033) and visceral injuries (P=.049), while there is a tendency without a statistical significal between Tile C and costal fractures. 61.9% (n=26) needed blood transfusion; 9.5% (n=4) presented hypovolemic shock. ConclusionsTile A pelvic fractures were associated with scapular fractures, and Tile B with transforaminal fractures of the sacrum and with visceral injuries (lungs, liver and genitourinary). The small number of Tile C prevent us to confirm an association with any pathology, although they are the ones which presnt more hemodynamically instability and thoracic injuries.

Sexual Dysfunction in Women after Traumatic Pelvic Fracture Negatively Affects Quality of Life and Mental Health

BackgroundWhile the impact of female sexual dysfunction (FSD) on mental health and overall health-related quality of life (HrQOL) has been previously documented, no prior work has evaluated this relationship in women following traumatic pelvic injuries. AimThis study aims to understand the relationship of FSD with HrQOL and depression in women with a history of traumatic pelvic fracture. MethodsData were collected with an electronic survey that included queries regarding mental and sexual health. Inverse probability weighting and multivariate regression models were utilized to assess the relationships between sexual dysfunction, depression and HrQOL. OutcomesStudy outcome measures included the Female Sexual Function Index (FSFI) to evaluate sexual functioning, the 8-item patient health questionnaire (PHQ-8) to assess depression symptoms, and the visual analog scale (VAS) component of the EuroQol 5 Dimensions Questionnaire (EQ-5D) to determine self-reported HrQOL. ResultsWomen reporting FSD had significantly higher PHQ-8 scores with a median PHQ-8 score of 6 (IQR 2, 11) relative to those without FSD who had a median score of 2 (IQR 0, 2) (P < .001). On multivariate linear regression, presence of FSD was significantly associated with higher PHQ-8 scores (β = 4.91, 95% CI 2.8–7.0, P < .001). FSFI score, time from injury, and age were all independently associated with improved HrQOL, with FSFI having the largest effect size (β = 0.62, 95% CI 0.30–0.95, P < .001). Clinical ImplicationsThese results underscore importance of addressing not just sexual health, but also mental health in female pelvic fracture survivors in the post-injury setting. Strengths and LimitationsThis study is one of the first to examine women with traumatic pelvic fractures who did not sustain concomitant urinary tract injuries. Study limitations include low response rate and the inherent limitations of a cross-sectional study design. ConclusionPatients with persistent, unaddressed FSD after pelvic fracture are at unique risk for experiencing depression and reporting worse health-related quality of life due to complex biopsychosocial mechanisms.Gambrah HA, Hagedorn JC, Dmochowski RR, et al. Sexual Dysfunction in Women after Traumatic Pelvic Fracture Negatively Affects Quality of Life and Mental Health. J Sex Med 2022;19:1759–1765.

Diagnostic accuracy of pelvic radiographs for the detection of traumatic pelvic fractures in the elderly.

Prompt identification of traumatic pelvic fractures in the elderly is critical to guide clinical management; however, the accuracy of pelvic radiographs is often compromised by multiple factors. The purpose of this study is to examine the diagnostic accuracy of radiographs for the detection of pelvic fractures, with CT as the standard of reference. A retrospective review was performed of patients ≥ 65years with traumatic pelvic fractures evaluated with both pelvic radiography and computed tomography (CT) from May 2016 to October 2019. Pelvic fractures were classified into fractures of the pubis, ilium, ischium, sacrum, and acetabulum. All pelvic radiographs were independently reviewed by two emergency radiologists. Original CT reports were utilized for the reference standard. 177 patients were included, with a total of 555 fractures. The mean age was 81years and 68% were female. The most common mechanism of injury was fall (62%), followed by motor vehicle accidents (18%). The most fractured bone was the pubis (314/555 fractures). Global pooled sensitivity for pelvic radiographs in detecting pelvic fractures compared to CT was 48%, with a specificity of 93%. Sensitivity for the detection of pelvic fractures is classified by the following types: pubis 61%, acetabulum 60%, ilium 41%, sacrum 20%, and ischium 17%. Eighteen patients (10%) required surgical fixation. Mortality was 8%. Pelvic radiographs have low sensitivity in detecting traumatic pelvic fractures. These radiographically occult fractures may be clinically significant as a cause of long-term pain and may require orthopedic consultation and possible surgical management.

Retrospective observational study correlating traumatic pelvic fractures and their associated injuries according to the Tile classification

IntroductionPelvic fractures due to high energy trauma present a high risk of associated injuries that compromise the functional and vital prognosis of the patients. The objective of this study was to analyze the relationship between traumatic pelvic fractures and their associated injuries according to the Tile classification. MethodsRetrospective observational study of patients who suffered traumatic pelvic fractures (Type A, B or C of the Tile classification) with concomitant associated injuries, analyzing hemoglobin levels, between 6/2013 and 1/2016. ResultsA total of 42 patients were included; of those 69% (n = 29) were males, mean age was 48 years. 45% (n = 19) suffered traffic accidents and 26.2% (n = 11) falls. There was a different proportion in pelvic injuries: Tile A (n = 15, 35.7%), B (n = 20, 47.6%), and C (n = 7, 16.6%) of cases. 54.8% (n = 23) underwent surgery, 21.4% (n = 9) needed temporary or definitive external fixation. Significant differences were found between Tile A type and scapula fractures (P = .032), and Tile B with sacral fractures (P = .033) and visceral injuries (P = .049), while there is a tendency without a statistical significal between Tile C and costal fractures. 61.9% (n = 26) needed blood transfusion; 9.5% (n = 4) presented hypovolemic shock. ConclusionsTile A pelvic fractures were associated with scapular fractures, and Tile B with transforaminal fractures of the sacrum and with visceral injuries (lungs, liver and genitourinary). The small number of Tile C prevent us to confirm an association with any pathology, although they are the ones which presnt more hemodynamically instability and thoracic injuries.

Pelvic Fractures and the Application of Pelvic Binders in Athletic Training

Context With the rise of athletic trainers (ATs) providing care to more nontraditional sports such as skiing, motor sports, rodeo, and X Games, the potential for dealing with traumatic pelvic injuries has increased from the traditional setting. The prehospital care provided by the AT can greatly reduce the potential complications seen in these patients. Application of a pelvic binder should be integrated into the athletic training education curriculum. Objective To provide the presentation of traumatic pelvic fractures, various types of pelvic binders available in the prehospital setting, and integration and teaching of this skill to professional level athletic training students. Description Students should be able to recognize and assess traumatic pelvic injuries. Proper treatment of these injuries is presented with a step-by-step process of how to manage these injuries in the prehospital setting. Equipment needs and how to teach this within the athletic training setting are discussed. Clinical Advantage(s) Integrating the application of the pelvic binder into current athletic training curricula helps provide ATs another tool to use in helping to prevent blood loss, shock, or death in patients with a possible traumatic pelvic fracture. Conclusion(s) Traumatic pelvic fractures are an important critical injury that must be assessed and addressed promptly to avoid hemorrhage and other sequela.

Comparison of mortality among hemorrhage-control methods performed for hemodynamically unstable patients with traumatic pelvic fractures: A multi-center study

/Objective: We aimed to analyze the effects of hemorrhage control methods on the mortality of patients with hemodynamic instability due to pelvic fracture and investigate independent mortality risk factors in these patients. Ninety-seven pelvic bone fracture patients with hemodynamic instability who visited the emergency departments of two university hospitals over 5 years were enrolled. These patients were categorized based on 28-day mortality (survival group) and acute hemorrhage mortality (non-survival group). Forty-seven patients (48.5%) underwent pelvic angiography; 45 (46.4%), pre-peritoneal pelvic packing; and 19 (19.6%), external fixation. Differences in hemorrhage control methods did not significantly affect mortality. However, there was a significant difference in mortality between the groups with and without hemorrhage control methods. Multivariate logistic regression analysis revealed that patient age, trauma and injury severity score (probability of survival), and blood transfusion amount within 24h were independent risk factors for 28-day mortality. Meanwhile, patient age, Glasgow coma scale (GCS) score, systolic blood pressure (SBP), and blood transfusion amount within 24h were independent risk factors for mortality due to acute hemorrhage. Rapid and appropriate application of hemorrhage control methods can reduce acute hemorrhage-related mortality in hemodynamically unstable patients with pelvic fractures. Moreover, none of the hemorrhage control methods were superior for the decreasing mortality rate in these patients.

Abstract No. 21 Transcatheter arterial embolization outcomes in pediatric pelvic fractures: a National Trauma Data Bank analysis

Traumatic pelvic fractures are associated with high morbidity and mortality due to the presence of life-threatening hemorrhage. While transcatheter arterial embolization is an established therapy for pelvic hemorrhage control in the adult trauma population, large scale studies supporting its application to pediatric patients remain sparse. This population-based study thus aims to assess the efficacy of transcatheter arterial embolization in the setting of pediatric pelvic fractures.

Understanding sexual health concerns in women after traumatic pelvic fracture

While there is a well-known association between pelvic fracture and sexual dysfunction, few studies discuss the treatment patterns and utilization of healthcare services following injury. Those that do exist pertain to men. How women experience sexual dysfunction after traumatic injury and how they navigate the healthcare system is currently not well documented in the literature. This study aims to understand the prevalence and spectrum of sexual health issues in women after pelvic fracture, and to highlight barriers associated with accessing care for these concerns. Women admitted and treated for traumatic pelvic fractures at a single Level 1 trauma center over a 6-year period were invited to participate in an electronic cross-sectional survey. Sexual health issues and care-seeking behaviors around sexual health were assessed. Inverse probability weighting based on available common data points in the registry was utilized to adjust for nonresponse bias. All data presented are of weighted data unless otherwise specified. Of the 780 potential subjects, 98 women responded to the survey (12.6% crude response rate). With weighting, 71% of responders were white and 42% had private insurance, with a mean age at the time of injury of 42.2 years (SD 22.4) and median time since the injury of 45 months (interquartile range: 30.0, 57.4). 49.5% stated that sexual function was important to very important to their quality of life, with an additional 25.3% reporting it was moderately important. Of responders, 59.0% (95% confidence interval:47.1%-71.0%) reported de novo postinjury sexual dysfunction. Specific complaints included dyspareunia (37.1%), difficulty with sexual satisfaction (34.4%), difficulty with sexual desire (31.3%), difficulty with orgasm (26.0%), and genital pain (17.8%). Of those with postinjury sexual dysfunction, 30.4% of women reported spontaneous resolution without treatment. An additional 15.4% indicated that they have continued concerns and desire treatment. Only 11.6% of women stated they had received treatment, all patients with access to insurance. Of those with postinjury sexual dysfunction, 60.8% had sexual health discussions with providers, 83.3% of which were patient-initiated. Common reasons why patients with sexual dysfunction did not raise the topic of sexual health with providers included embarrassment/fear (23.6%), assuming the issue would resolve with time (23.5%), sexual health not being a health priority (22.4%), and lack of information about the condition or available treatments (19.9%). Sexual dysfunction is common in women after traumatic pelvic fracture, with patients experiencing dysfunction in multiple domains. Concerns are inadequately addressed in the healthcare setting due to several modifiable barriers at both the patient and provider levels. Standardization in the postinjury recovery period is needed to better address patients' sexual health concerns.

English

Acute onset of breathlessness and type 1 respiratory failure in young patients in the orthopaedic ward with traumatic pelvic or long bone fractures often raise suspicion of thromboembolic event, classic fat embolism and fat embolism syndrome (FES). However, in the era of the prevailing pandemic, the clinical presentation may cause suspicion of Covid-19 infection, creating a dilemma for diagnostic purposes, causing inadvertent delays in definitive management. Although clinically significant in 30 % of cases, FES in subclinical form is believed to be occurring in a large percentage of patients with long bone and pelvic fractures, secondary to a rise in intramedullary pressure and venous sinusoidal disruption. Debris of bone and fat gain access to the systemic and pulmonary circulation cause mechanical obstruction as well as multi-organ dysfunction syndrome. FES can be recognised by classic Bergman’s triad1 characterised by hypoxaemia, petechial rash and mental changes. We present a case of fat embolism syndrome that was reported in a tertiary care centre during the peak of the Covid19 pandemic.

Does Time to Pelvic Fixation Influence Outcomes in Trauma Patients?

Pelvic fractures cause significant morbidity in the trauma population. Many factors influence time to fracture fixation. No previous study has determined the optimal time window for pelvic fixation. A retrospective review of trauma patients with pelvic fractures from 2016 to 2020 was performed. Patients were stratified into EARLY and LATE groups, by time to fixation within 3days or greater than 3days whether from admission or from completion of a life-saving procedure. Unpaired Student's t-test and Fisher's exact test were performed with multiple linear regression for variables with P < .2 on univariate analysis. 287 patients were identified with a median fixation time of 3days. There was no significant difference in demographics, incidence of preceding life-saving procedure, angioembolization, or mechanism of injury in the 2 groups (P > .05). Length of stay in the EARLY group was significantly reduced at 11.9 +/- .7days compared to 18.0 +/-1.2days in the LATE group (P < .001). There was no significant difference in rates of ventilator-associated pneumonia, deep vein thrombosis, pulmonary embolism (PE), acute kidney injury (AKI), pressure ulcer, or acute respiratory distress syndrome (ARDS) (P > .05). There were significantly more SSIs (surgical site infections) in the LATE group. After multiple linear regression adjusting for covariates of age and ISS, the difference in hospital LOS was 5.5 days (95% CI -8.0 to -3.1, P < .001). Fixation of traumatic pelvic fractures within 3days reduced LOS. Prospective multi-center studies will help identify additional factors to decrease time to surgery and improve patient outcomes.

MP04-06 SEXUAL DYSFUNCTION ON QUALITY OF LIFE AFTER PELVIC FRACTURE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-06 SEXUAL DYSFUNCTION ON QUALITY OF LIFE AFTER PELVIC FRACTURE Alice Wang, Monica Vavilala, Frederick Rivara, and Niels Johnsen Alice WangAlice Wang More articles by this author , Monica VavilalaMonica Vavilala More articles by this author , Frederick RivaraFrederick Rivara More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life in men. METHODS: 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated post-injury health-related quality of life and sexual function. Inverse probability weighting was utilized to adjust for survey non-response. Pelvic fracture characteristics were classified based on the Orthopaedic Trauma Association (OTA) classification system. Sexual function was evaluated utilizing the International Index of Erectile Function (IIEF) and health-related quality of life (HrQOL) was evaluated utilizing the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL. RESULTS: After inverse probability weighting and adjustment for potential confounders, a decrease in IIEF was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (ß=0.28, p=0.02). No association was identified between OTA pelvic fracture configuration and risk of post-injury erectile dysfunction (ED) (p=0.99). 53.3% of men reported persistent ED at a median of 42.6 months (IQR 28.0, 63.3) following injury. The presence of ED was independently associated with a decrease in HrQOL (ß=10.92, p<0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10-years for men with ED following pelvic fracture relative to those without. CONCLUSIONS: Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation. Source of Funding: 2018 Sexual Medicine Society of North America Pfizer Research Fellowship in Men's Health © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e69-e69 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alice Wang More articles by this author Monica Vavilala More articles by this author Frederick Rivara More articles by this author Niels Johnsen More articles by this author Expand All Advertisement Loading ...

The effect of sexual dysfunction on health-related quality of life in men following traumatic pelvic fractures.

Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life (HrQOL) in men. A total of 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated postinjury HrQOL and sexual function. Inverse probability weighting was used to adjust for survey nonresponse. Pelvic fracture characteristics were classified based on the Orthopedic Trauma Association classification system. Sexual function was evaluated using the International Index of Erectile Function, and HrQOL was evaluated using the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL. After inverse probability weighting and adjustment for potential confounders, a decrease in International Index of Erectile Function was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (β = 0.28, p = 0.02). No association was identified between Orthopedic Trauma Association pelvic fracture configuration and risk of postinjury erectile dysfunction (ED) (p = 0.99). Furthermore, 53.3% of men reported persistent ED at a median of 42.6 months (interquartile range, 28.0-63.3 months) following injury. The presence of ED was independently associated with a decrease in HrQOL (β = 10.92, p < 0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10 years for men with ED following pelvic fracture relative to those without. Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation. Prognostic, level IV.

Abstract No. 45 Contemporary trends in the management and outcome of patients with traumatic pelvic fractures: a National Trauma Data Bank study

To compare the utilization and clinical outcomes of different procedures used for the management of traumatic pelvic fractures Using National Trauma Data Bank (NTDB) from 2007 to 2015, adult patients with pelvic fractures were identified. Those with other life-threatening injuries were excluded. The factors for the receipt of various therapies were then identified using chi-square as univariate analysis (UVA). The therapies included were the following: internal or external fixation, laparotomy ± fixation or arterial embolization (AE) ± fixation, or combination of laparotomy and AE ± fixation. Using a linear mixed regression and logistic regression models and correcting for factors that were statistically significant on UVA, the outcomes for each therapy was evaluated: length of stay (LOS), ICU days, and mortality. Overall, 12687 patients were included, and the cohort was predominantly male (68.9%) and white (66.3%). Of the entire cohort, 2924 (23%) patients underwent internal and/or fixation only. The number of patients who underwent laparotomies ± fixation was 5485 (43.2%) and those of AE was 3532(27.8%). Overall, 746 (6%) patients underwent combination of laparotomy and AE ± fixation. The following clinical and demographic factors were found to be predictors of receipt of various therapies: year of the injury, patient’s age, gender, ethnicity, severity of injury and presence of shock (Ps < 0.001). When correcting for all these factors, LOS for the AE group was lower compared to laparotomy group 11.33 days versus 13.64 days (P < 0.001), and also ICU days for the AE group was lower compared to laparotomy group 7.04 days versus 9.64 days (P < 0.001). Additionally, the mortality rate was higher in the laparotomy group compared to AE group (OR = 3.67, 3.39-3.98, P < 0.001). LOS, ICU days and mortality were higher in combination group compared to both AE or laparotomy groups (Ps< 0.001). Embolization with or without laparotomy appears to be an integral part of the management of adults with traumatic pelvic fracture. Compared to laparotomy, embolization has shorter LOS and ICU days. Laparotomy group has a higher mortality rate compared to embolization group.