Introduction
Facture of bone is a common condition that can happen to anyone at any age. The term ‘fracture’ is a medical term for a broken bone. It can be due to increased pressure on the bone, like during a fall or a hit. It can also occur when the density or strength of the bone is less so that even a small fall can cause a break in the bone.
What Is a Fracture?
A complete or partial discontinuity of the bone is called a fracture. It can happen to anyone, irrespective of age or gender. However, older women have a higher risk of a fracture. This is probably due to an increase in osteoporosis with aging. Osteoporosis is a condition where the bone becomes weak, with a tendency to break easily.
There are many types of fracture. A closed fracture is a discontinuity in the bone with no damage to the surrounding tissue or a tear in the skin. On the other hand, a compound fracture causes a tear in the surrounding tissues. The skin is usually penetrated in this type of fracture. Compound fractures are more severe than simple fractures. This is mainly because the chance of infection is higher in a compound fracture, as it is an open wound.
Does Fracture Occur in Pregnancy?
Orthopedic injuries are rare in pregnancy. Studies show reports of one to six percent of pregnant women who had bone fractures during pregnancies. It is a rare condition. However, there are high chances of maternal and fetal morbidity and mortality associated with the condition. Studies show about forty percent of intra-uterine fetal deaths are associated with pelvic ring fractures.
The management of fractures in pregnant patients is challenging. The anatomic and physiologic changes in pregnancy increase the complexity. Fetal loss, preterm birth (birth that occurs before the expected due date, or thirty-seventh week of pregnancy), placental abruption (a severe condition where the placenta detaches from the embryo), increased chance of cesarean delivery, and even maternal death could be the risks associated. Life-threatening injuries include those involving the pelvis and acetabulum (the socket of the hip bone). Before the surgery, the benefits and dangers involved must be considered. Understanding the hazards associated with giving anesthesia, antibiotics, anticoagulants, and radiation exposure is important. The positioning of the patient might determine the viability of the patient.
How Are Bone Fractures in Pregnancy Diagnosed?
Stabilization and examination of the pregnant patient’s vital signs are considered important. Cardiotocography (a procedure done to monitor the fetal heart rate and the contraction of the uterus during pregnancy) and high-resolution ultrasonography can be done in cases where the fetus has a gestational age older than twenty-four weeks. It helps to get details on the movements of the fetus, its heart rate, and if the placenta is still intact. The fetus should be monitored for twenty-four hours if the patient has any complications like abdominal pain, tenderness, or contractions in the uterus, vaginal bleeding, rupture of membranes, fluid leak, abnormal fetal heart rate, etc.
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Imaging: The International Commission on Radiological Protection, the American College of Radiology, the National Council on Radiation Protection and Measurements, and the American College of Obstetricians and Gynecologists states that if the benefits outweigh the risks of using an imaging study in a case of bone fracture in a pregnant woman, it should be considered. It should be the safest and most appropriate diagnostic procedure that can provide an accurate diagnosis. The National Council on Radiation Protection and Measurements states that the maximum cumulative radiation (total radiation exposed) dose to a fetus during pregnancy should not exceed five rads.
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Prophylactic Therapy: The same indications for non-pregnant women can also be applied to pregnant women. However, the only thing to be considered is that it should be pregnancy-safe, or it should not cause any harm to the fetus inside the mother’s womb. Cephalosporins, penicillins, and macrolides are the antibiotics that are considered safe during pregnancy. Cefazolin can be given to a pregnant woman for a hip repair or any other surgical procedure. An alternative to this drug in a woman allergic to penicillin can be clindamycin or vancomycin. All drugs contraindicated in pregnancy should not be given. Low molecular weight heparins have been replaced with UPF (unfractionated heparin) in pregnant women with orthopedic procedures. The risk of heparin-induced thrombocytopenia (a condition in which the patient’s platelet count is lower than required), other side effects, and osteoporosis are reduced with low molecular weight heparin. This is because they do not cross the placenta, have an easier schedule for administration, and are not required to monitor anticoagulant activity.
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Anesthesia: An anesthetist experienced in dealing with surgeries related to pregnancy-related bone fractures. This is mainly because of the different anatomy, physiology, pharmacokinetics, and pharmacodynamics of pregnant women and fetuses. If there is a possibility, the surgical procedure will be delayed till the pregnant woman completes the first trimester.
How Are Bone Fractures in Pregnancy Managed?
The fact that two lives are being taken care of in a single body increases the challenge of the procedure. The fixation that requires the least amount of radiation while maintaining the care of fracture should be the primary objective of fracture fixation. Usually, minimally invasive percutaneous plating is used to correct the fracture. Very complicated surgical procedures and procedures that require cumulative radiation exposure are avoided in pregnancy, and other alternatives will be sought. However, if the benefits outweigh the risks, it can be proceeded taking the required precautions.
Surgical management (if unavoidable) should have the shortest duration possible. Precautions should be taken to reduce peri-operative complications. However, any emergency open fractures, fatal injuries, or injuries that cause vascular injury should be treated, even if the patient is pregnant, to save the patient’s life.
What Is the Prognosis of a Bone Fracture Treated in Pregnancy?
All fractures have the same prognosis as that of an average woman. However, it also depends on the location of the fracture. If appropriate care is given, fractures in the hands and legs have a good prognosis. However, fractures in the hip and pelvic areas can be challenging. It might call for a cesarean delivery if it occurs in the later stages of pregnancy. Healing might take eight to twelve weeks in case of any fracture.
Conclusion
The changes in the body during pregnancy matter in every step of a bone fracture. It starts with the mode of investigation and treatment to be given. The fact that two souls in a single body are being considered increases the complexity of the condition.
