MANAGEMENT OF LOWER LIMB TRAUMA IN 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.