Pelvic fractures in women of childbearing age.

Clin Orthop Relat Res 468(7):1781-9 (2010) PMID 20333494 PMCID PMC2881988

BACKGROUND: Pelvic fractures represent major injury. Women of childbearing age who have sustained pelvic fractures question whether they can have children and what type of delivery will be possible. QUESTIONS/PURPOSES: (1) Genitourinary and sexual dysfunction can be expected in women of child bearing age with pelvic fractures; (2) functional outcomes of women with pelvic fractures are related to fracture pattern and whether they were treated with surgery; (3) women treated nonoperatively and those treated operatively with fixation sparing the pubic symphysis can deliver children vaginally. METHODS: We retrospectively reviewed 71 women with pelvic fractures. Forty-one had stable fractures and 25 had unstable fractures; five radiographs could not be located to classify fractures. Forty women had surgery for their pelvic fractures. RESULTS: Thirty-five women (49%) had one or more genitourinary complaints; 26 women (38%) had pain with sexual intercourse. The overall SF-12 score and physical and mental health component were lower in women who had surgical fixation of their pelvic fracture. Overall SF-12 scores were similar in women who did and did not have children after their pelvic fracture. Twenty-six women had children after their pelvic fracture: 10 (38%) delivered vaginally; 16 (62%) had a cesarean section. Four (40%) of the women who delivered vaginally had surgical fixation of their fracture, including rami screws and/or sacroiliac screws. CONCLUSIONS: Our data suggest the cesarean section rate is still more than double standard norms, but vaginal delivery after pelvic fracture, even in those treated with surgical fixation sparing the pubic symphysis, is possible. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.