Orthopedic operation linked to erection problems

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About 40 percent of men who undergo “intramedullary nailing” for a broken thighbone, also called the femur, report Erectile dysfunction (ED) afterwards, according to a recent report by French researchers. Receiving adequate amounts of muscle relaxant during the operation may help reduce the risk.

As the name implies, intramedullary nailing involves the placement of long pins into the bone to stabilize the fracture. The technique is used for a variety of bone fractures, not just those involving the femur.

Pelvic nerves, referred to as the “pudendals”, are known to play a key role in erections, senior author Dr. Bernard Malavaud, from CHU-Toulouse Rangueil, and colleagues note. The stretching and pulling that occurs during intramedullary femoral nailing may damage these nerves. Therefore, this operation may increase the risk of ED.

To investigate, the researchers used a standard questionnaire to compare the sexual outcomes of 101 patients who underwent nailing of a fractured femur or tibia, also called the shinbone. The authors selected tibia fractures as a comparison because the nailing is similar to that used with femoral fractures, but doesn’t affect the pudendals.

Nearly 41 percent of patients in the femoral fracture group reported ED compared with 12.5 percent of patients in the tibial fracture group, according to the report in the medical journal Urology.

When the analysis was confined to patients who had experienced high-impact trauma, a higher rate of ED was still seen in the femoral fracture group. This suggests that Post-traumatic Stress Disorder, which could occur in any case of high-impact trauma, played little or no role in the erection problems seen, the authors note.

Further analysis showed that patients without ED received a higher dose of curare, a muscle relaxant, during surgery than those with dysfunction, supporting the idea that optimal muscle relaxation during surgery reduces the risk of postoperative ED.

Overall, the findings suggest that ED is common after femoral nailing, but that the risk may be reduced with adequate muscle relaxation during the procedure, the investigators conclude.

SOURCE: Urology, March 2005.

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