Sexual function after pelvic ring fractures: does injury mechanism matter?

Abstract

Background: Pelvic ring fractures are severe injuries frequently associated with neurological, vascular, and urogenital damage. Although sexual dysfunction represents a major determinant of long-term quality of life, its relationship with the initial injury mechanism remains poorly explored.

Objective: To evaluate male sexual function after surgically treated pelvic ring fractures and to compare outcomes according to the injury mechanism defined by the Young and Burgess classification.

Methods: This retrospective single-centre study (Angers University Hospital) included male patients aged 18-75 years who underwent surgical treatment for pelvic ring fractures between January 2020 and June 2024. Fractures were classified into anteroposterior compression (APC), lateral compression (LC), and vertical shear (VS) groups. Sexual function was assessed at a minimum of 9 months postoperatively using the International Index of Erectile Function (IIEF-5). Univariate analyses were conducted to explore potential confounding factors. Statistical comparisons were performed between groups.

Results: Thirty-one patients were included (15 APC, 10 LC, 6 VS). The mean follow-up was 22.8 ± 11.9 months. A significant difference in IIEF-5 scores was observed among the three groups (Kruskal-Wallis test, H = 13.45, p = 0.0012), with a large non-parametric effect size (epsilon-squared, ε² = 0.41). The LC group demonstrated significantly higher scores (19.4 ± 5.8) compared with the APC (15.8 ± 4.7) and VS groups (7.2 ± 0.8). All patients in the VS group exhibited severe erectile dysfunction. No statistically significant differences in age, surgical approach, or follow-up duration were identified, although these findings should be interpreted cautiously given the limited sample size.

Conclusion: These exploratory findings suggest an association between injury mechanism and sexual outcomes after pelvic ring fractures. LC fractures appear associated with better functional recovery, whereas APC and especially VS fractures may carry a higher risk of persistent sexual dysfunction. However, residual confounding related to associated urethral, neurological, vascular, psychological, or systemic trauma-related factors cannot be excluded. Given the small sample size, results should be interpreted with caution. Systematic screening and multidisciplinary management should be considered in high-risk patients.