Pelvic ring fracture and erectile dysfunction (PERFECD) - 3 year follow-up cross sectional study

Pelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury.

Between January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21-25 points), mild ED (16-21 points), moderate ED (9-15 points), and severe ED (5-7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking.

A total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05).

Vertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED.