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J Am Acad Orthop Surg, Vol 14, No 3, March 2006, 175-182.
© 2006 the American Academy of Orthopaedic Surgeons
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Orthopaedic Trauma in the Pregnant Patient

Kyle Flik, MD, Peter Kloen, MD, PhD, Jose B. Toro, MD, William Urmey, MD, Jan G. Nijhuis, MD, PhD and David L. Helfet, MD

Dr. Flik is Attending Orthopaedic Surgeon, Northeast Orthopaedics, LLP, Albany, NY. Dr. Kloen is Director, Orthopaedic Trauma, Academic Medical Center, Amsterdam, The Netherlands. Dr. Toro is Orthopaedic Trauma Fellow, Hospital for Special Surgery, New York, NY. Dr. Urmey is Assistant Attending Anesthesiologist, Hospital for Special Surgery. Dr. Nijhuis is Professor, Obstetrics, and Head, Division of Maternal-Fetal-Medicine, Academic Hospital Maastricht, Maastricht, The Netherlands. Dr. Helfet is Attending Orthopaedic Surgeon and Chief, Orthopaedic Trauma Service, Hospital for Special Surgery.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Flik, Dr. Kloen, Dr. Toro, Dr. Urmey, Dr. Nijhuis, and Dr. Helfet.

Reprint requests: Dr. Helfet, Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

Trauma affects up to 8% of pregnancies and is the leading cause of death among pregnant women in the United States. A pregnancy test is mandated for all females of childbearing age who are involved in trauma. Orthopaedic trauma in the pregnant patient is managed similarly to that for all trauma patients. Initial resuscitation efforts should focus on the pregnant patient because stable patient vital signs provide the best chance for fetal survival. In the stable patient, fetal assessment and a pelvic examination are mandatory. Radiographs as well as abdominal ultrasound of the patient and fetal ultrasound are useful. No known biologic risks are associated with magnetic resonance imaging, and no specific fetal abnormalities have been linked with standard low-intensity magnetic resonance imaging. Emergency surgery can be safely performed in most pregnant patients. Avoiding patient hypotension and using left lateral decubitus positioning increase the likelihood of success for the patient and fetus. An experienced multidisciplinary team consisting of an obstetrician, perinatologist, orthopaedic surgeon, anesthesiologist, radiologist, and nursing staff will optimize the treatment of both the pregnant patient and her fetus.






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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.