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Treatment of Pregnant Patients With Orthopaedic Trauma

Tejwani, Nirmal MD; Klifto, Kevin PharmD; Looze, Christopher MD; Klifto, Christopher Scott MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p e90–e101
doi: 10.5435/JAAOS-D-16-00289
Review Article

Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered. The risks posed by anesthetic agents, antibiotic agents, anticoagulant agents, and radiation exposure must be understood. Positioning of the patient can affect the viability of the fetus. If surgery is necessary, the left lateral decubitus position decreases fetal hypotension. A specialized team including an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, radiologist, and nurse must collaborate to improve maternal and fetal outcomes.

From the NYU Hospital for Joint Diseases, New York, NY (Dr. Tejwani, Dr. Looze, and Dr. C. Klifto), and the Philadelphia College of Osteopathic Medicine, Philadelphia, PA (Dr. K. Klifto).

Dr. Tejwani or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of and serves as a paid consultant to Stryker and Zimmer Biomet and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the Foundation for Orthopaedic Trauma, and the Orthopaedic Trauma Association. Dr. Looze or an immediate family member is an employee of Amgen. Dr. C. Klifto or an immediate family member has stock or stock options held in GE Healthcare, Johnson & Johnson, Merck, and Pfizer. Neither Dr. K. Klifto nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received April 26, 2016

Received in revised form November 14, 2016

Accepted January 03, 2017

© 2017 by American Academy of Orthopaedic Surgeons
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