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Shaath MK, Garrett C, Pattisapu N, Routt MLC. Obstetricians are likely to elect for cesarean section in women with retained pelvic implants: a radiographic survey study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1345-1348. [PMID: 38133652 DOI: 10.1007/s00590-023-03803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Women with a history of pelvic fracture undergo cesarean section (CS) at a higher rate than the general population. The purpose of our study is to query obstetricians on their preferences. METHODS An electronic survey consisting of 22 radiographs of patients who underwent pelvic fixation was sent to obstetricians at 3 academic medical centers. For each radiograph, a hypothetical scenario was given, and the respondents were asked if they would elect for a vaginal delivery or CS. RESULTS We collected 58 responses. The overall CS rate was 59%. Respondents were significantly more likely to elect for CS with trans-symphyseal fixation or sacroiliac fixation, independently (p < 0.001). DISCUSSION Obstetricians are likely to elect for elective CS in the presence of pelvic implants especially in patients with trans-symphyseal and sacroiliac fixation. Based on there is an opportunity for collaboration between orthopedic trauma surgeons and obstetricians.
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Affiliation(s)
- M Kareem Shaath
- Orlando Health Jewett Orthopedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 60 Columbia St., Orlando, FL, 32806, USA.
| | - Christopher Garrett
- Orlando Health Jewett Orthopedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 60 Columbia St., Orlando, FL, 32806, USA
| | | | - Milton L Chip Routt
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, McGovern Medical School at UTHealth, Houston, USA
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Basile A, Palmieri L, Lanzetti R, Sessa P, Spoliti M, Giai Via A, Pipino G. Suprapatellar intramedullary nailing of tibial shaft fractures in pregnancy. A report of two cases. BMC Pregnancy Childbirth 2022; 22:528. [PMID: 35765043 PMCID: PMC9241291 DOI: 10.1186/s12884-022-04835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Treatment of closed tibial shaft fractures in the 3rd trimester of pregnancy is controversial. Since there are few case reports published in literature, there is no consensus on the appropriate management of these fractures. This case report proposes intramedullary nailing throught the suprapatellar approach for the treatment of tibial shaft fracture in pregnant women, never described before in literature. Case presentation We report 2 cases of a tibial diaphyseal fracture treated by intramedullary nailing in women at the 3rd trimester of pregnancy. Conclusion Surgical treatment of tibial shaft fracture of pregnant women in the 3rd trimester of pregnancy with intramedullary nailing seems to be safe. The use of the specific suprapatellar approach helps in the intra-operative management of the pregnant patients.
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Affiliation(s)
- Attilio Basile
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Laura Palmieri
- Department of Orthopedic Surgery and Traumatology, Policlinico Tor Vergata, School of Medicine, University of Tor Vergata, Rome, Italy
| | - Riccardo Lanzetti
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Pasquale Sessa
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Spoliti
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alessio Giai Via
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy. .,School of Medicine, University of Salerno, Salerno, Italy.
| | - Gennaro Pipino
- UCM Malta University, campus Lugano, Lugano, Switzerland.,Department of Orthopedic Surgery and Traumatology, Villa Erbosa Hospital, Gruppo San Donato, Bologna, Italy
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Pregnancy and delivery after pelvic fracture in fertile-aged women: A nationwide population-based cohort study in Finland. Eur J Obstet Gynecol Reprod Biol 2022; 270:126-132. [DOI: 10.1016/j.ejogrb.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
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Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy. J Am Acad Orthop Surg 2021; 29:e805-e814. [PMID: 34043597 DOI: 10.5435/jaaos-d-21-00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 02/01/2023] Open
Abstract
There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.
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Sridharan G, Panneerselvam E, Ponvel K, Tarun S, Krishna Kumar Raja VB. Maxillofacial trauma in a pregnant patient: Contemporary management principles with a case report & review of literature. Chin J Traumatol 2020; 23:78-83. [PMID: 32178998 PMCID: PMC7156954 DOI: 10.1016/j.cjtee.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 02/04/2023] Open
Abstract
Trauma during pregnancy deserves special attention because of its management objectives, i.e. well-being of both pregnant woman and foetus. Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening, mastication and breathing. Hence early restitution of form and function of maxillofacial skeleton is essential. However, the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment. A careful scrutiny of the patient's systemic and gestational status is absolutely essential before, during and after instituting any interventional procedures. We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester (32 weeks). She was treated with inter maxillary fixation using orthodontic brackets & elastics. After successful restitution of occlusion, the patient was advised aggressive physiotherapy which ensured normal mouth opening. Two weeks later, the patient delivered uneventfully. The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion, mouth opening and lower facial height. This article aims at analyzing the contemporary principles in management of maxillofacial trauma in a pregnant woman and clarifying the common misconceptions.
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Affiliation(s)
- Geetha Sridharan
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India.
| | - Keerthana Ponvel
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
| | - Swetha Tarun
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
| | - V B Krishna Kumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
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Internal hemipelvectomy is a safe procedure and provides a satisfying outcome for pelvic chondrosarcoma with coexisting pregnancy. J Clin Orthop Trauma 2019; 10:1059-1064. [PMID: 31708628 PMCID: PMC6835009 DOI: 10.1016/j.jcot.2019.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 12/20/2022] Open
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Yoo BJ. Pelvic Trauma and the Pregnant Patient: a Review of Physiology, Treatment Risks, and Options. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0136-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To determine whether certain patterns of pelvic ring injury are associated with more frequent intrauterine fetal demise (IUFD). DESIGN Retrospective review. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Of 44 pregnant patients with pelvic and/or acetabular fractures, 40 had complete records that allowed determination of fetal viability. χ2 tests were used for categorical variables (Fisher exact tests when expected cell counts were fewer than 5), and t tests were used for continuous variables. MAIN OUTCOME MEASUREMENTS Fetal or maternal death. RESULTS Sixteen patients had isolated acetabular fractures, 25 had isolated pelvic ring injuries, and 3 had acetabular fractures with concomitant pelvic ring injuries. Maternal and fetal mortality were 2% and 40%, respectively. No patients with isolated acetabular fractures experienced IUFD, compared with 68% (15/22) of those with isolated pelvic ring injuries (P < 0.0001). Eight (53%) of 15 IUFDs were associated with lateral compression (LC)-I pelvic ring injuries (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 61-B2). Of the 13 LC-I pelvic ring injuries, 8 (62%) resulted in IUFD. Pelvic ring stability, Young-Burgess classification, and operative treatment were not associated with IUFD. Maternal Glasgow Coma Scale (average 13.2) and Injury Severity Score (average 18.2) at admission were predictive of IUFD. CONCLUSIONS The most frequent pelvic fractures in gravid trauma patients are LC-I. Although the rate of maternal mortality was low, the risk of IUFD was quite high (40%). LC-I pelvic ring injuries often had catastrophic outcomes, with IUFD in 62% of cases. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
Visceral and somatic causes of pelvic pain are often inter-related, and a musculoskeletal examination should always be considered for the successful diagnosis and treatment of pelvic pain. For the diverse etiologies of hip pain, there are many unique considerations for the diagnosis and treatment of these various disorders. Pelvic pain is often multidimensional due to the overlap between lumbo-hip-pelvic diagnoses and may require a multidisciplinary approach to evaluation and management.
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Affiliation(s)
- Kate E Temme
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard Street, 1st Floor, Philadelphia, PA 19146, USA; Department of Orthopaedics, University of Pennsylvania, 1800 Lombard Street, 1st Floor, Philadelphia, PA 19146, USA.
| | - Jason Pan
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard Street, 1st Floor, Philadelphia, PA 19146, USA
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Abstract
Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered. The risks posed by anesthetic agents, antibiotic agents, anticoagulant agents, and radiation exposure must be understood. Positioning of the patient can affect the viability of the fetus. If surgery is necessary, the left lateral decubitus position decreases fetal hypotension. A specialized team including an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, radiologist, and nurse must collaborate to improve maternal and fetal outcomes.
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Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, Kluger Y, Moore EE, Peitzman AB, Ivatury R, Coimbra R, Fraga GP, Pereira B, Rizoli S, Kirkpatrick A, Leppaniemi A, Manfredi R, Magnone S, Chiara O, Solaini L, Ceresoli M, Allievi N, Arvieux C, Velmahos G, Balogh Z, Naidoo N, Weber D, Abu-Zidan F, Sartelli M, Ansaloni L. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 2017; 12:5. [PMID: 28115984 PMCID: PMC5241998 DOI: 10.1186/s13017-017-0117-6] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/12/2017] [Indexed: 01/24/2023] Open
Abstract
Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Philip F Stahel
- Department of Orthopedic Surgery and Department of Neurosurgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO USA
| | - Giulia Montori
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Walter Biffl
- Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA
| | - Tal M Horer
- Dept. of Cardiothoracic and Vascular Surgery & Dept. Of Surgery Örebro University Hospital and Örebro University, Örebro, Sweden
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel
| | | | - Andrew B Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, Pensylvania USA
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | | | - Bruno Pereira
- Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery Foothills Medical Centre, Calgary, AB Canada
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Roberto Manfredi
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Stefano Magnone
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Osvaldo Chiara
- Emergency and Trauma Surgery, Niguarda Hospital, Milan, Italy
| | - Leonardo Solaini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Marco Ceresoli
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Niccolò Allievi
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Catherine Arvieux
- Digestive and Emergency Surgery, UGA-Université Grenoble Alpes, Grenoble, France
| | - George Velmahos
- Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston, MA USA
| | - Zsolt Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Noel Naidoo
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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13
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Stohlner V, Gill JR, Murphy CG, Carrothers AD. Definitive use of external fixation for pelvic ring injuries (open book/APC2) in pregnancy. BMJ Case Rep 2015; 2015:bcr-2015-212690. [PMID: 26677154 DOI: 10.1136/bcr-2015-212690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pelvic fractures in pregnancy are rare, resulting in a paucity of evidence-based management. We describe a case of open book pelvic injury in a 32-year-old woman in her third trimester of pregnancy. She was successfully managed with a supra-acetabular external fixator, which allowed the safe delivery of a healthy baby boy at 34 weeks, via caesarean section. The external fixator was removed postpartum, when the pelvis was deemed stable, and mother and baby both continue to do well. This is the only case in the literature that demonstrates the successful use of external fixation for pelvic injuries in pregnancy.
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Affiliation(s)
- V Stohlner
- NHS FT, Cambridge University, Cambridge, UK
| | - J R Gill
- Department of Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - C G Murphy
- Department of Orthopaedics, Cambridge University Hospitals NHS FT NHS, Cambridge, Cambridgeshire, UK
| | - A D Carrothers
- Department of Orthopaedics, Cambridge University Hospitals NHS FT NHS, Cambridge, Cambridgeshire, UK
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Matthews LJ, McConda DB, Lalli TAJ, Daffner SD. Orthostetrics: Management of Orthopedic Conditions in the Pregnant Patient. Orthopedics 2015; 38:e874-80. [PMID: 26488781 DOI: 10.3928/01477447-20151002-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/04/2015] [Indexed: 02/03/2023]
Abstract
Managing orthopedic conditions in pregnant patients leads to challenges that must be carefully considered so that the safety of both the mother and the fetus is maintained. Both perioperative and intraoperative considerations must be made based on physiologic changes during pregnancy, risks of radiation, and recommendations for monitoring. Operative timing, imaging, and medication selection are also factors that may vary based on trimester and clinical scenario. Pregnancy introduces unique parameters that can result in undesirable outcomes for both mother and fetus if not handled appropriately. Ultimately, pregnant patients offer a distinct challenge to the orthopedic surgeon in that the well-being of 2 patients must be considered in all aspects of care. In addition, not only does pregnancy affect the management of orthopedic conditions but the pregnant state also causes physiologic changes that may actually induce various pathologies. These pregnancy-related orthopedic conditions can interfere with an otherwise healthy pregnancy and should be recognized as possible complications. Although the management of orthopedic conditions in pregnancy is often conservative, pregnancy does not necessarily preclude safely treating pathologies operatively. When surgery is considered, regional anesthesia provides less overall drug exposure to the fetus and less variability in fetal heart rate. Intraoperative fluoroscopy can be used when appropriate, with 360° fetal shielding if possible. Lateral decubitus positioning is ideal to prevent hypotension associated with compression of the inferior vena cava.
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Abstract
Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated.
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Yamaguchi T, Yamauchi Y, Yamaguchi J, Hara K. Fractures of the pubic rami and sacrum identified after delivery. Int J Obstet Anesth 2014; 24:91-3. [PMID: 25499014 DOI: 10.1016/j.ijoa.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/21/2014] [Accepted: 08/19/2014] [Indexed: 01/13/2023]
Affiliation(s)
- T Yamaguchi
- Department of Anesthesia, Tsushima Izuhara Hospital, Nagasaki, Japan.
| | - Y Yamauchi
- Department of Obstetrics and Gynecology, Tsushima Izuhara Hospital, Nagasaki, Japan
| | - J Yamaguchi
- Department of Obstetrics and Gynecology, Tsushima Izuhara Hospital, Nagasaki, Japan
| | - K Hara
- Department of Obstetrics and Gynecology, Tsushima Izuhara Hospital, Nagasaki, Japan
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