Update on open reduction and internal fixation of unstable pelvic fractures during pregnancy: case reports

Management of Pelvic Fractures and Hip Dislocation in Pregnancy: A Case Report and Review of Literature

Introduction

Trauma is the leading non-obstetric cause of maternal mortality during pregnancy and pelvic fractures are challenging to manage in such cases due to the effect of trauma on the gravid uterus and altered maternal physiology. About 8-16% of pregnant females can have fatal outcome after trauma, with pelvic fractures contributing majorly to the same, and also can have severe fetomaternal complications. There are only two cases reported till date of hip dislocation in pregnancy, with very little literature available on its outcome.

Case Report

We, hereby, present a case of a 40-year-old pregnant female hit by a moving car with the right superior and inferior pubic rami fracture and left anterior hip dislocation. Closed reduction of the left hip was done under anesthesia and pubic rami fractures were managed conservatively. On follow-up after 3 months, the fracture was completely healed and the patient had a normal vaginal delivery. We have also reviewed management protocols for such cases. Aggressive maternal resuscitation is important for both maternal and fetal survival. Pelvic fractures should not be left unreduced in such cases to prevent mechanical dystocia and can have a good outcome with both closed and open reduction and fixation techniques.

Conclusion

Pelvic fractures in pregnancy should be treated by careful maternal resuscitation and timely intervention. The majority of such patients can deliver vaginally if the fracture heals before delivery.

Orthopedic Trauma During Pregnancy; a Narrative Review

Introduction

Blunt traumas, like road accidents and falls, are common causes of injuries to pregnant women, and the major risk factors are young age and low socioeconomic level. Due to physiological and anatomical changes specific to pregnancy, such as changes in blood pressure and hemoglobin drop, trauma management involves certain complexities. Physical trauma is estimated to cause at least 1 complication in every 12 pregnancies. This study aims to evaluate orthopedic trauma during pregnancy and appreciate the different approaches to circumvent the resultant challenges.

Methods

We reviewed 55 articles, published on orthopedic trauma during pregnancy between 2011 and 2021. The articles were identified by searching PubMed, google-scholar, Scopus, and Science-Direct. We utilized the search terms: fall in pregnancy, traumas in pregnancy, motor vehicle accident/crash in pregnancy, blunt trauma in pregnancy, pregnant trauma patient, penetrating injury during pregnancy, assault, interpersonal violence in pregnancy, and mortality and pregnancy.

Results

According to available reports, after stabilizing the pregnant patient, diagnostic procedures, including radiography, and even gadolinium-based techniques when needed, can be performed to examine extensive trauma. In contrast to elective orthopedic surgery, emergency orthopedic surgeries, including reduction of open fractures, should be performed promptly.

Conclusion

Based on our investigation, pregnant women with orthopedic injuries that are severe, or even seemingly less severe, experience significantly increased adverse pregnancy outcomes, which include preterm birth, placental abruption, poor infant condition at birth, infant death, and even maternal death.

Maxillofacial trauma in a pregnant patient: Contemporary management principles with a case report & review of literature

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.