Báo cáo y học: Accelerated tibial fracture union in the third trimester of pregnancy: a case report

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Báo cáo y học: "Accelerated tibial fracture union in the third trimester of pregnancy: a case report"Journal of Medical Case Reports BioMed Central Open AccessCase reportAccelerated tibial fracture union in the third trimester ofpregnancy: a case reportMudussar A Ahmad*, Damayanthi Kuhanendran, Irvine W Kamande andCharalambos CharalambidesAddress: Department of Trauma & Orthopaedics, The Whittington University Hospital, London, UKEmail: Mudussar A Ahmad* - mudussarahmad@hotmail.com; Damayanthi Kuhanendran - damy007@hotmail.com;Irvine W Kamande - Irvinekamande@hotmail.com; Charalambos Charalambides - charalambos.charalambides@whittington.nhs.uk* Corresponding authorPublished: 9 February 2008 Received: 9 November 2007 Accepted: 9 February 2008Journal of Medical Case Reports 2008, 2:44 doi:10.1186/1752-1947-2-44This article is available from: http://www.jmedicalcasereports.com/content/2/1/44© 2008 Ahmad et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction: We 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 presentation: A 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. Conclusion: Long 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. with the addition of wound infection, osteomyelitis andIntroductionTibial fractures are the second most common long bone fat embolism.fracture. Treatment varies according to fracture displace-ment, complexity and whether the fracture is open or Surgical intervention in pregnancy presents a risk to theclosed. The options are non-operative treatment, with foetus. However surgery can be successfully performedplaster immobilization and traction, or operative treat- when a multidisciplinary team approach is used [1].ment, with intra-medullary nailing, plating and externalfixation. The potential complications of non-operative Fracture healing occurs in three phases: inflammatory,treatment include delayed union, mal-union and non- reparative and remodelling [2]. This is a dynamic processunion. Operative management has similar complications which is mainly regulated by local interactions among cells and tissues around the fracture site. Tissue repair is Page 1 of 4 (page number not for citation purposes)Journal of Medical Case Reports 2008, 2:44 http://www.jmedicalcasereports.com/content/2/1/44also influenced by hormones that act systemically, such as weight bearing through the plaster without pain. Clinicalinsulin and glucocorticoid, and gonadal hormones, such examination revealed no pain or movement at the ...