MANAGEMENT OF LOWER LIMB TRAUMA IN PREGNANCY

Authors

  • Sukhil Raina Department of Orthopaedics, Government Medical College, Patiala, Punjab, India. https://orcid.org/0000-0002-1903-0002
  • Mandeep Singh Department of Orthopaedics, Government Medical College, Patiala, Punjab, India.
  • Priya Sahni Department of Community Medicine, SGRD Institute of Medical Sciences, Amritsar, Punjab, India.
  • Preetkanwal Sibia Department of OBG, Government Medical College, Patiala, Punjab, India.
  • Girish Sahni Department of Orthopaedics, Government Medical College, Patiala, Punjab, India. https://orcid.org/0000-0003-2748-4108
  • Navneet Kaur Department of OBG, Government Medical College, Patiala, Punjab, India.

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i6.47257

Keywords:

Orthopedics, Lower limb trauma, Pregnancy

Abstract

Objective: Lower limb fracture in pregnancy is a rare complication. Still, there is limited literature available on the management of these fractures, and perioperative obstetric and orthopedic management of these fractures is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death and a significant public health burden. This study reviews the common causes of lower limb trauma during pregnancy, morbidity, mortality, and provides a management approach to pregnant patients with lower limb trauma.

Methods: A prospective analysis was conducted in the orthopedics department of Government Medical College, Patiala from 2019–2022 on 30 pregnant patients admitted here with lower limb fractures.18 patients presented with femoral fractures and 12 patients with tibial fractures. Details of the type of fracture and site of fracture, along with the type of intervention, were recorded. Roadside accident was the most common cause of trauma, followed by fall and then assault.

Results: The following observations were made from the data collected during this study in the treatment of 30 cases of lower limb trauma during pregnancy. The mean age of patients in the study was 27 years. The most common cause of trauma was traffic accidents, followed by fall and assault. In our study, 18 patients (60%) presented with femoral fractures, and 12 patients (40%) with tibial fractures. Operative intervention was done for all femoral fractures and 6 tibia fractures.6 tibial fractures were managed conservatively. Among 18 femoral fractures, 15 were operated with plating and 3 with interlocking femur nails. Among 6 operated tibia fractures, 2 were operated with plating and 4 with interlocking tibia nail. All cases were evaluated with risks and benefits of operative treatment, positioning of the patient, type of anesthesia used, use of c-arm, radiation dose, intraoperative fetal monitoring and the risk associated with anesthetic agents, antibiotics, analgesics, and anticoagulants.

Conclusions: Orthopedic trauma during pregnancy is usually associated with significant morbidity and mortality to the mother as well as fetus. A multidisciplinary approach should be used for the successful management of lower limb fractures during pregnancy. The orthopedic surgeon must consider both operative and non-operative measures. Risk and benefits of operative treatment must be weighed carefully. Many fractures during pregnancy can be managed conservatively based on the fracture pattern and displacement. Also, we can delay the operative treatment until after delivery which is often a safe option. In fractures where surgical intervention is necessary, orthopedic surgeons must consider the physiologic changes that accompany pregnancy and the potential risks to the fetus. The surgeon must take care of the proper positioning of the patient, use of the c-arm, radiation dose, and intraoperative fetal monitoring. Furthermore, the risk associated with anesthetic agents, antibiotics, analgesics, and anticoagulants must be taken care of.

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References

Cannada LK, Pan P, Casey BM, McIntire DD, Shafi S, Leveno KJ. Pregnancy outcomes after orthopedic trauma. J Trauma 2010;69:694-8; discussion 698. doi: 10.1097/TA.0b013e3181e97ed8, PMID 20838141

Kafiabadi MJ, Sabaghzadeh A, Khabiri SS, Sadighi M, Mehrvar A, Biglari F, et al. Orthopedic trauma during pregnancy; a narrative review. Arch Acad Emerg Med 2022;10:e39. doi: 10.22037/aaem.v10i1.1573, PMID 35765609

Bhatia P, Chhabra S. Physiological and anatomical changes of pregnancy: Implications for anaesthesia. Indian J Anaesth 2018;62:651- 7. doi: 10.4103/ija.IJA_458_18, PMID 30237589.

Shah AJ, Kilcline BA. Trauma in pregnancy. Emerg Med Clin North Am 2003;21:615-29. doi: 10.1016/s0733-8627(03)00038-5, PMID 12962349

Rudloff U. Trauma in pregnancy. Arch Gynecol Obstet 2007;276:101- 17. doi: 10.1007/s00404-006-0308-y, PMID 17219159

Brown S, Mozurkewich E. Trauma during pregnancy. Obstet Gynecol Clin North Am 2013;40:47-57. doi: 10.1016/j.ogc.2012.11.004, PMID 23466136

Weinlein JC, Mashru RP, Perez EA, Johnson SE. Lateral compression-I pelvic ring injury: Not benign to the developing fetus. J Orthop Trauma 2018;32:100-3. doi: 10.1097/BOT.0000000000001030, PMID 28906307

Ogle JA. Improving web site performance using commercially available analytical tools. Clin Orthop Relat Res 2010;468:2604-11. doi: 10.1007/s11999-010-1333-5, PMID 20361280

Rees GA, Willis BA. Resuscitation in late pregnancy. Anaesthesia 1988;43:347-9. doi: 10.1111/j.1365-2044.1988.tb09009.x, PMID 3400842

Committee opinion No. 696: Nonobstetric surgery during pregnancy. Am Coll Obstet Gynecol Obstet Gynecol 2017;129:777-8.

Labronici PJ, Lyra FS, Moreira IL Jr., Hoffmann R, Franco JS, de Toledo Lourenço PR, et al. Fractures of the distal extremity of the tibia treated with intramedullary nail or bridge plate: Comparison of radiation exposure between the two methods. Rev Bras Ortop 2010;45:132-5. doi: 10.1016/S2255-4971(15)30281-0, PMID 27022530

North DL. Radiation doses in pregnant women. J Am Coll Surg 2002;194:100-1. doi: 10.1016/s1072-7515(01)01126-7, PMID 11800333

Berlin L. Radiation exposure and the pregnant patient. AJR Am J Roentgenol 1996;167:1377-9. doi: 10.2214/ajr.167.6.8956562, PMID 8956562

Published

07-06-2023

How to Cite

Raina, S., M. Singh, P. Sahni, P. Sibia, G. Sahni, and N. Kaur. “MANAGEMENT OF LOWER LIMB TRAUMA IN PREGNANCY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 16, no. 6, June 2023, pp. 26-29, doi:10.22159/ajpcr.2023.v16i6.47257.

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Original Article(s)