Orthostetrics: Management of Orthopedic Conditions in the Pregnant Patient

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.

Corticosteroid Injection for an Orthopedic Complaint in a Female with Gestational Diabetes

“…Our patient was experiencing meralgia paresthetica and trochanteric bursitis, both orthopedic conditions that can be related to the physiologic and anatomic changes of pregnancy [ 1 , 2 ]. Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs indicated for various orthopedic complaints including refractory meralgia paresthetica and trochanteric bursitis.…”

An Original Minimally Invasive Percutaneous Plate Osteosynthesis (Mippo) for Distal Fractures of the Tibia at the First Trimester of Pregnancy

“…Up to 8% of pregnancies are affected by trauma [2]; it is the primary cause of non-obstetric maternal death. Falls and motor vehicle crashes are the most common mechanisms of injury [2]. The operative treatment of closed distal tibial fractures in the first trimester of pregnancy remains controversial.…”

“…However, it has been reported in the literature that the fracture union is accelerated because of the changed hormonal status during pregnancy [4] and a surgery planned later will be technically difficult in this case. There is no conclusive evidence that the technique of anesthesia, general or regional, has an impact on pregnancy outcome or that either type is safer than the other [2].…”

“…Warfarin is absolutely contraindicated and this drug should never be used during pregnancy. Low-molecular-weight heparins or unfractionated heparin at prophylactic doses are used for anticoagulation during pregnancy [7]. Category C: agents that may induce risk to the fetus Category D: agents that should be avoided.…”

Compressive radial neuropathy by a synovial cyst during pregnancy

“…Local anesthesia is associated with lower overall drug exposure and less variability in fetal heart rate. [16] In this study, a regional axillary nerve block was applied, which achieved a good surgical outcome without fetal or maternal compromise.…”