Skip to main content
SpringerLink
Log in

Pelvic Fractures in Women of Childbearing Age

  • Symposium: Gender-specific Issues in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr., Poka A, Bathon GH, Brumback RJ. Pelviv ring disruption: effective classification system and treatment protocols. J Trauma. 1990;30:848–856.

    Article  CAS  PubMed  Google Scholar 

  2. Copeland CE, Bosse MJ, McCarthy ML, MacKenzie EJ, Guzinski GM, Hash CS, Burgess AR. Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function. J Orthop Trauma. 1997;11:73–81.

    Article  CAS  PubMed  Google Scholar 

  3. Guillemette J, Fraser WD. Differences between obstetricians in caesarean section rates and the management of labour. Br J Obstet Gynaecol. 1992;99:105–108.

    Article  CAS  PubMed  Google Scholar 

  4. Holbrook TL, Hoyt DB. The impact of major trauma: quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. J Trauma. 2004;56:284–290.

    Article  PubMed  Google Scholar 

  5. Kellam JF, Mayo K. Pelvic ring disruption. Pelvic fractures. In: Browner BD, Jupiter JJ, Levine AM, Trafton PG, eds. Skeletal Trauma. 3rd Ed. Philadelphia, PA: WB Saunders; 2003:1063.

  6. Krishnamurthy S, Fairlie F, Cameron AD, Walker JJ, Mackenzie JR. The role of postnatal x-ray pelvimetry after caesarean section in the management of subsequent delivery. Br J Obstet Gynaecol. 1991;98:716–718.

    Article  CAS  PubMed  Google Scholar 

  7. LeFaivre KA, Padelecki JR, Starr AJ. What constitutes a Young and Burgess lateral compression I (OTA 61-B2) pelvic ring disruption? A description of computed tomography-based fracture anatomy and associated injuries. J Orthop Trauma. 2009;23:16–21.

    Article  PubMed  Google Scholar 

  8. Lev-Weisel R, Chen R, Daphna-Tekoah S, Hod M. Past traumatic events: are they a risk factor for high-risk pregnancy, delivery complications and post-partum post-traumatic symptoms? J Womens Health. 2009;18:119–125.

    Article  Google Scholar 

  9. MacDorman MF, Menacker F, Declerq E. Cesarean births in the United States: epidemiology, trends and outcomes. Clin Perinatol. 2008;35:293–307.

    Article  PubMed  Google Scholar 

  10. Madsen LV, Jensen J, Christensen ST. Parturition and pelvic fracture. Follow-up of 34 obstetric patients with a history of pelvic fracture. Acta Obstet Gynecol Scand. 1983;62:617–620.

    Article  CAS  PubMed  Google Scholar 

  11. McCarthy ML, Mackenzie EJ, Bosse MJ, Copeland CE, Hash CS, Burgess AR. Functional status following orthopaedic trauma in young women. J Trauma. 1995;39:828–837.

    Article  CAS  PubMed  Google Scholar 

  12. Mulla N. Fracture of the pelvis in pregnancy. Am J Obstet Gynecol. 1957;74:246–250.

    CAS  PubMed  Google Scholar 

  13. Sathy AK, Starr AJ, Smith WR, Elliot A, Agudelo J, Reinert CM, Minei JP. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am; 2009:91;2803–2810.

    Article  PubMed  Google Scholar 

  14. Schuman W. Fractured pelvis in obstetrics (with report of cases). Am J Obstet Gynecol. 1932;23:103–107.

    Google Scholar 

  15. Speer DP, Peltier LF. Pelvic fractures and pregnancy. J Trauma. 1972;12:474–480.

    Article  CAS  PubMed  Google Scholar 

  16. Starr AJ, Smith WR, Frawley WH, Borer DS, Morgan SJ, Reinert CM, Mendoza-Welch M. Symptoms of posttraumatic stress disorder after orthopaedic trauma. J Bone Joint Surg Am. 2004;86:1115–1121.

    Article  PubMed  Google Scholar 

  17. Yang YT, Mello MM, Subramanian SV, Studdert DM. Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section. Med Care. 2009;47:234–242.

    Article  PubMed  Google Scholar 

  18. Zhou SR. Fracture-dislocation of pelvis in the adult female: clinical analysis of 105 cases. Zhonga Wai Ke Za Zhi. 1989;27:479–481, 509–510.

    Google Scholar 

Download references

Acknowledgments

We thank Heidi Israel, PhD, St Louis University Department of Orthopaedic Surgery, for providing the statistics for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, St Louis University, 3635 Vista Avenue, 7th Floor Desloge Towers, St Louis, MO, 63110, USA

    Lisa K. Cannada MD

  2. University of Mississippi Medical Center, Jackson, MS, USA

    Jennifer Barr MD

Authors
  1. Lisa K. Cannada MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Barr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa K. Cannada MD.

Additional information

The author’s institutions (LKC, University of Texas-Southwestern Medical Center and St Louis University; JB, University of Mississippi) received research support for this study from the Foundation for Orthopaedic Trauma and the Ruth Jackson Orthopaedic Society Zimmer Research Award.

Each author certifies that her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the University of Texas-Southwestern Medical Center, Dallas, TX, USA, and the University of Mississippi Medical Center, Jackson, MS, USA.

Appendices

Appendix 1 Information/Consent Packet Contents

  1. 1.

    Letter Explaining Study

  2. 2.

    HIPPA Form and Consent

  3. 3.

    Consent

  4. 4.

    Release Form to Obstetrician (if patient had child after pelvic fracture)

  5. 5.

    Questionnaire (see Appendix 2)

  6. 6.

    SF 12

Appendix 2

Pelvic Fractures and Childbirth

figure afigure afigure a

Appendix 3

Parturition and Pelvic Fractures

figure b

About this article

Cite this article

Cannada, L.K., Barr, J. Pelvic Fractures in Women of Childbearing Age. Clin Orthop Relat Res 468, 1781–1789 (2010). https://doi.org/10.1007/s11999-010-1289-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1289-5

Keywords

Search

Navigation