Abstract
IntroductionWe present a case of accelerated tibial fracture union in the third trimester of pregnancy. This is of particular relevance to orthopaedic surgeons, who must be made aware of the potentially accelerated healing response in pregnancy and the requirement for prompt treatment.Case presentationA 40 year old woman at 34 weeks gestational age sustained a displaced fracture of the tibial shaft. This was initially treated conservatively in plaster with view to intra-medullary nailing postpartum. Following an emergency caesarean section, the patient was able to fully weight bear without pain 4 weeks post injury, indicating clinical union. Radiographs demonstrated radiological union with good alignment and abundant callus formation. Fracture union occurred within 4 weeks, less than half the time expected for a conservatively treated tibial shaft fracture.ConclusionLong bone fractures in pregnancy require clear and precise management plans as fracture healing is potentially accelerated. Non-operative treatment is advisable provided satisfactory alignment of the fracture is achieved.
Highlights
We present a case of accelerated tibial fracture union in the third trimester of pregnancy
We present a case of accelerated tibial fracture union in a pregnant woman
Fracture healing is influenced by factors related to the injury and those related to the patient
Summary
Tibial fractures are the second most common long bone fracture. Treatment varies according to fracture displacement, complexity and whether the fracture is open or closed. We present a case of accelerated tibial fracture union in a pregnant woman. Previous medical history included thalassaemia trait and severe bipolar affective disorder which was being treated with Lithium Carbonate and prochlorperazine She was a non-smoker and did not drink alcohol. The initial plan was non-operative treatment until postpartum, after which the fracture would be stabilised by an intra-medullary nail. She was admitted to hospital and a below knee backslab followed by a full Sarmiento cast applied. The patient was allowed to fully mobilise as tolerated in an air cast boot and reviewed in four weeks with a further radiograph that showed a consolidated fully healed fracture The patient was asymptomatic with no clinical deformity and a full range of pain free motion in her ankle and knee
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