Introduction: Pelvic fractures are responsible for genito-urinary injuries in 25% of cases. The objective of this study was to assess the severity and psychological impact of erectile dysfunction in patients with pelvic ring fractures.
Hypothesis: Unstable pelvic fractures are associated with erectile dysfunction and depression.
Patients and method: We retrospectively reviewed consecutive patients older than 18 years who were admitted to the orthopaedic and trauma surgery department of the Antananarivo university hospital, Madagascar, over a 3-year period (2014-2016) for pelvic ring fractures. Erectile function was assessed using the 5-item International Index of Erectile Function questionnaire (IIEF-5) and mood using the Major Depression Inventory (MDI). All patients were invited to attend a visit to complete both questionnaires.
Results: The study included 48 patients with a mean age of 39 years (range, 18-82 years) and a mean follow-up of 12 months. The fracture was due to a traffic accident in 81.2% of patients and occurred as one of multiple injuries in 22.9% of patients. The fracture was stable in 34 (70.8%) patients (type A1, 16 patients; type A2, 18 patients) and unstable in 14 (29.5%) patients (type B, 9 patients; type C, 5 patients). Erectile dysfunction was found in 16 (33.3%) patients and was severe in 6, moderate in 4, and mild in 6. Erectile dysfunction was more common in the patients who had type C fractures. Depression was associated with severe erectile dysfunction.
Conclusion: Erectile function should be assessed in the medium and long term in patients with pelvic ring fractures. If left untreated, erectile dysfunction may lead to depression in these often young patients.
Level of evidence: IV, retrospective observational study.
Keywords: Depression; Erectile dysfunction; Fracture; Pelvis; Tile classification.
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