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Hill KL, Gross ME, Sutton KM, Mulcahey MK. Evaluation and Resuscitation of the Pregnant Orthopaedic Trauma Patient: Considerations for Maternal and Fetal Outcomes. JBJS Rev 2020; 7:e3. [PMID: 31841448 DOI: 10.2106/jbjs.rvw.19.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kelly L Hill
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
| | - Maya E Gross
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
| | | | - Mary K Mulcahey
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
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Combined Acetabulum Fracture and Hip Dislocation in an 18-Year-Old Female at 35-Week Gestation: A Case Report and Review of the Literature. Case Rep Orthop 2020; 2020:8888015. [PMID: 32774967 PMCID: PMC7396045 DOI: 10.1155/2020/8888015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Caring for an injured, pregnant patient can be a management challenge. We report the case of an 18-year-old female who sustained a left acetabulum fracture with a concurrent hip dislocation at 35 weeks' gestation following a motor vehicle accident. Through an interdisciplinary, team-based approach, the patient was guided through obstetric delivery and orthopedic surgical fracture fixation without complication. By being familiar with the unique challenges in management posed by pregnant patients, orthopedic surgeons can be better equipped to minimize morbidity and mortality in this patient population while maximizing clinical outcomes.
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Harold JA, Isaacson E, Palatnik A. Femoral fracture in pregnancy: a case series and review of clinical management. Int J Womens Health 2019; 11:267-271. [PMID: 31114393 PMCID: PMC6497842 DOI: 10.2147/ijwh.s198345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/16/2019] [Indexed: 11/23/2022] Open
Abstract
Femoral fractures in pregnancy are a rare complication, with an incidence of approximately 1%. Case reports and small trials leave perioperative obstetric management and route of delivery largely unclear. Three cases of femoral fracture are presented that occurred at 24, 30, and 31 weeks of gestation. The causes of femoral fracture were gunshot, motor vehicle collision, and fragility fracture. All fractures were surgically repaired, 1 utilizing neuraxial anesthesia and the others with general anesthesia. A 30-day postoperative course of low-molecular-weight heparin was prescribed, and all patients subsequently had vaginal deliveries. Femoral fractures in the viable pregnancy confer high maternal and fetal morbidity and mortality. Intraoperative fetal monitoring and postoperative anticoagulation should be considered, and vaginal delivery should not be contraindicated.
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Affiliation(s)
- Justin A Harold
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erin Isaacson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
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Schwartsmann CR, Macedo CADS, Galia CR, Miranda RH, Spinelli LDF, Ferreira MT. Update on open reduction and internal fixation of unstable pelvic fractures during pregnancy: case reports. Rev Bras Ortop 2018; 53:118-124. [PMID: 29367917 PMCID: PMC5771786 DOI: 10.1016/j.rboe.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/23/2017] [Indexed: 12/02/2022] Open
Abstract
This article aims to report four cases of unstable pelvic fractures in pregnant women treated by open reduction and internal fixation. Cases report The study included four cases of pregnant women with unstable pelvic fractures; their outcomes were analyzed and discussed. Data were obtained from two University Hospitals. The mean age of women was 23 years; most (3/4) were primiparous, with a mean pregnancy age of 23 weeks. Two women had Malgaigne-type fractures and the other two had symphyseal disjunction associated with acetabular fractures. All fractures were treated surgically. One foetus was dead on admission to hospital. The other three developed well, along with their mothers. Good evolution was only possible with careful pre-, peri-, and postoperative care for the mother, as well as foetal assessment by a multidisciplinary team. In complex cases such as those presented in the present study, pre-, peri-, and postoperative care are mandatory, as well as the presence of a multidisciplinary team. The mother's life always takes priority in acute clinical pictures, as it offers the best chance of survival to both mother and child.
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Affiliation(s)
- Carlos Roberto Schwartsmann
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Departamento de Ortopedia e Traumatologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carlos Alberto de Souza Macedo
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Departamento de Ortopedia e Traumatologia, Hospital das Clínicas do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carlos Roberto Galia
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Departamento de Ortopedia e Traumatologia, Hospital das Clínicas do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Horta Miranda
- Departamento de Ortopedia e Traumatologia, Hospital Mater Dei, Belo Horizonte, MG, Brazil
| | - Leandro de Freitas Spinelli
- Departamento de Ortopedia e Traumatologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marco Tonding Ferreira
- Departamento de Ortopedia e Traumatologia, Hospital Mater Dei, Belo Horizonte, MG, Brazil
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Schwartsmann CR, Macedo CADS, Galia CR, Miranda RH, Spinelli LDF, Ferreira MT. Redução aberta e fixação interna em fraturas da pelve instáveis durante a gestação: relato de casos. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Tv R, P R, Grover A, Samorekar B. Bilateral distal radius fracture in third trimester of pregnancy with accelerated union: a rare case report. J Clin Diagn Res 2015; 9:RD01-2. [PMID: 26023611 DOI: 10.7860/jcdr/2015/11498.5751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
Abstract
Bilateral distal radius fracture is a rare entity. There is no literature reporting a bilateral distal radius fracture in pregnancy. Fracture healing is influenced by hormones. Hormonal changes of pregnancy will affect the healing of a fracture. A 28-year-old female at 34 wk of pregnancy sustained a bilateral distal radius fracture after a self fall. One side was managed conservatively and open reduction was done for the other side. Both fractures united at four weeks. This case is unique in three ways. First distal radius fractures commonly occur in elderly postmenopausal females due to oestrogen deficiency. In this case a distal radius fracture occurred following a self fall in third trimester of pregnancy - a hyperestrogenic state. Second the time taken for union was only four weeks signifying the hormonal effects on pregnancy on fracture healing. Third the occurrence of bilateral distal radius fracture itself is very rare in adults. In pregnancy there is a faster rate of fracture healing due to effects of oestrogen and increased cardiac output. Fractures in pregnancy require special attention. Surgical intervention should be done with a multidisciplinary approach. While management of fractures in pregnancy, effect of hormonal and physiological changes should be kept in mind.
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Affiliation(s)
- Ravikumar Tv
- Assistant Professor, Department of Orthopaedics, MS Ramaiah Medical College , Bangalore, India
| | - Rahul P
- Assistant Professor, Department of Orthopaedics, MS Ramaiah Medical College , Bangalore, India
| | - Amit Grover
- Postgraduate, Department of Orthopaedics, MS Ramaiah Medical College , Bangalore, Karnataka, India
| | - Bheemsingh Samorekar
- Postgraduate, Department of Orthopaedics, MS Ramaiah Medical College , Bangalore, Karnataka, India
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Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. Management of pelvic injuries in pregnancy. Orthop Clin North Am 2013; 44:301-15, viii. [PMID: 23827834 DOI: 10.1016/j.ocl.2013.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pelvic fractures in pregnant women are usually high-energy injuries associated with risk of mortality to both mother and fetus. The mother's life always takes priority in the acute setting as it offers the best chance of survival to both the mother and the fetus. Indications for operative intervention of acute pubic symphysis rupture depend on presence of an open disruption, amount of displacement, and degree of disability. Chronic symphyseal instability related to pregnancy is a challenging problem and the first line of treatment is nonoperative care. A previous pelvic fracture is not a contraindication by itself to vaginal delivery.
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Affiliation(s)
- Louis F Amorosa
- Department of Orthopaedic Surgery, New York Medical College, 19 Bradhurst Ave, Suite 1300, Hawthorne, NY 10532, USA.
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Abstract
OBJECTIVE To describe in utero radiation exposures in pregnant patients undergoing acetabular fracture repair. DESIGN Retrospective case series. SETTING University-affiliated regional trauma center. PATIENT/PARTICIPANTS Eight pregnant patients with acetabular fractures treated over a 6-year period. There were an additional 518 acetabular fractures in nonpregnant patients treated during the same time period. INTERVENTION Open reduction and internal fixation of the acetabulum fracture. OUTCOME MEASUREMENTS None. This is a descriptive series reporting fetal radiation doses, fetal fluoroscopy exposure times, and fetal viability after treatment. RESULTS The gestational age of the fetuses at presentation ranged from 5 to 26 weeks. Infant delivery averaged 27 weeks from the time of surgery and all pregnancies reached 36 weeks. Apgar scores were normal each child including 1 twin delivery. There were 4 posterior wall fractures, 3 transverse or posterior wall fractures, and 1 posterior column fracture. Intraoperative pelvic fluoroscopy averaged 39 seconds. There were no operative complications and fracture reductions were anatomic in 7 patients. Computed tomography scan of the pelvis conferred the greatest exposure risk to the fetus and fluoroscopy conferred the least. In each case that required a computed tomography scan of the pelvis, the calculated radiation exposure dose to the fetus was greater than 5 cGy. CONCLUSIONS The results of this study demonstrate that with a team approach and the judicious use of radiographic imaging during the surgical care of a displaced acetabular fracture in the pregnant patient, minimal risk to the baby can be achieved in pursuit of acceptable articular reductions.
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Ahmad MA, Kuhanendran D, Kamande IW, Charalambides C. Accelerated tibial fracture union in the third trimester of pregnancy: a case report. J Med Case Rep 2008; 2:44. [PMID: 18261239 PMCID: PMC2265291 DOI: 10.1186/1752-1947-2-44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 02/09/2008] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We present a case of accelerated tibial fracture union in the third trimester of pregnancy. This is of particular relevance to orthopaedic surgeons, who must be made aware of the potentially accelerated healing response in pregnancy and the requirement for prompt treatment. CASE PRESENTATION A 40 year old woman at 34 weeks gestational age sustained a displaced fracture of the tibial shaft. This was initially treated conservatively in plaster with view to intra-medullary nailing postpartum. Following an emergency caesarean section, the patient was able to fully weight bear without pain 4 weeks post injury, indicating clinical union. Radiographs demonstrated radiological union with good alignment and abundant callus formation. Fracture union occurred within 4 weeks, less than half the time expected for a conservatively treated tibial shaft fracture. CONCLUSION Long bone fractures in pregnancy require clear and precise management plans as fracture healing is potentially accelerated. Non-operative treatment is advisable provided satisfactory alignment of the fracture is achieved.
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Affiliation(s)
- Mudussar A Ahmad
- Department of Trauma & Orthopaedics, The Whittington University Hospital, London, UK.
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Tibial Nailing During Pregnancy: A Safe Option. Eur J Trauma Emerg Surg 2007; 34:80-2. [PMID: 26815496 DOI: 10.1007/s00068-007-6165-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 02/07/2007] [Indexed: 10/23/2022]
Abstract
We present a case of a distal tibial fracture in a pregnant patient treated with an intermedullary device. The risks associated with operative treatment of fractures in pregnancy are discussed. The patient underwent a successful procedure using a novel tibial nail which reduced both operative time and radiation exposure. Surgical intervention allowed the mother to have a normal delivery. The patient had an excellent outcome with no adverse effects reported by either mother or baby.
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Abstract
Trauma affects up to 8% of pregnancies and is the leading cause of death among pregnant women in the United States. A pregnancy test is mandated for all females of childbearing age who are involved in trauma. Orthopaedic trauma in the pregnant patient is managed similarly to that for all trauma patients. Initial resuscitation efforts should focus on the pregnant patient because stable patient vital signs provide the best chance for fetal survival. In the stable patient, fetal assessment and a pelvic examination are mandatory. Radiographs as well as abdominal ultrasound of the patient and fetal ultrasound are useful. No known biologic risks are associated with magnetic resonance imaging, and no specific fetal abnormalities have been linked with standard low-intensity magnetic resonance imaging. Emergency surgery can be safely performed in most pregnant patients. Avoiding patient hypotension and using left lateral decubitus positioning increase the likelihood of success for the patient and fetus. An experienced multidisciplinary team consisting of an obstetrician, perinatologist, orthopaedic surgeon, anesthesiologist, radiologist, and nursing staff will optimize the treatment of both the pregnant patient and her fetus.
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Affiliation(s)
- Kyle Flik
- Orthopaedic Surgeon, Northeast Orthopaedics, LLP, Albany, NY, USA
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