Femoral Fracture in Pregnancy: A Case Report and Review of Data from the Literature
Abstract
1. Introduction
2. Case Report
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Prajin, R.; Owais, A.; Armstrong, B.R.; Ramesh, P.; Dheenadhayalan, J.; Shanmuganathan, R. An interplay between orthopedic trauma and pregnancy—A case series of 42 patients. Injury 2024, 55, 11185. [Google Scholar] [CrossRef]
- Kafiabadi, M.J.; Sabaghzadeh, A.; Khabiri, S.S.; Sadighi, M.; Mehrvar, A.; Biglari, F.; Ebrahimpour, A. Orthopedic trauma during pregnancy; a narrative review. Arch. Acad. Emerg. Med. 2022, 10, e39. [Google Scholar] [CrossRef]
- Brown, S.; Mozurkewich, E. Trauma during pregnancy. Obs. Gynecol. Clin. N. Am. 2013, 40, 47–57. [Google Scholar] [CrossRef] [PubMed]
- El Kady, D.; Gilbert, W.M.; Xing, G.; Smith, L.H. Association of maternal fractures with adverse perinatal outcomes. Am. J. Obs. Gynecol. 2006, 195, 711–716. [Google Scholar] [CrossRef]
- Herath, M.; Wong, P.; Trinh, A.; Allan, C.A.; Wallace, E.M.; Ebeling, P.R.; Fuller, P.J.; Milat, F. Minimal-trauma ankle fractures predominate during pregnancy: A 17-year retrospective study. Arch. Osteoporos. 2017, 12, 86. [Google Scholar] [CrossRef]
- Harold, J.A.; Isaacson, E.; Palatnik, A. Femoral fracture in pregnancy: A case series and review of clinical management. Int. J. Women’s Health 2019, 11, 267–271. [Google Scholar]
- Hadji, P.; Boekhoff, J.; Hahn, M.; Hellmeyer, L.; Hars, O.; Kyvernitakis, I. Pregnancy-associated transient osteoporosis of the hip: Results of a case-control study. Arch. Osteoporos. 2017, 12, 11. [Google Scholar] [PubMed]
- Lampropoulou-Adamidou, K.; Trovas, G.; Stathopoulos, I.P.; Papaioannou, N.A. Case report: Teriparatide treatment in a case of severe pregnancy-and lactation- associated osteoporosis. Hormones 2012, 11, 495–500. [Google Scholar] [CrossRef]
- Tejwani, N.; Klifto, K.; Looze, C.; Klifto, S.C. Treatment of Pregnant Patients with Orthopaedic Trauma. J. Am. Acad. Orthop. Surg. 2017, 25, e90–e101. [Google Scholar] [CrossRef]
- American College of Obstetricians and Gynecologists. Committee opinion No. 696: Nonobstetric surgery during pregnancy. Am. Coll. Obs. Gynecol. Obs. Gynecol. 2017, 129, 777–778. [Google Scholar]
- Raina, S.; Singh, M.; Sahni, P.; Sibia, P.; Sahni, G.; Kaur, N. Management of lower limb trauma in pregnancy. Asian J. Pharm. Clin. Res. 2023, 16, 26–29. [Google Scholar] [CrossRef]
- Sorantin, E.; Heidari, N.; Pichler, K.; Weinberg, A.M. Fracture Management in the Pregnant Patient. In The Poly-Traumatized Patient with Fractures; Pape, H.C., Sanders, R., Borrelli, J., Jr., Eds.; Springer: Berlin/Heidelberg, Germany, 2016. [Google Scholar] [CrossRef]
- Weinlein, J.C.; Mashru, R.P.; Perez, E.A.; Johnson, S.E. Lateral compression-I pelvic ring injury: Not benign to the developing fetus. J. Orthop. Trauma 2018, 32, 100–103. [Google Scholar] [CrossRef] [PubMed]
- Cannada, L.K.; Barr, J. Pelvic fractures in women of childbearing age. Clin. Orthop. Relat. Res. 2010, 468, 1781–1789. [Google Scholar] [CrossRef] [PubMed]
- Cannada, L.K.; Pan, P.; Casey, B.M.; McIntire, D.D.; Shafi, S.; Leveno, K.J. Pregnancy outcomes after orthopedic trauma. J. Trauma 2010, 69, 694–698; discussion 698. [Google Scholar] [CrossRef] [PubMed]
- Sowers, M.; Crutchfield, M.; Jannausch, M.; Updike, S.; Corton, G. A prospective evaluation of bone mineral change in pregnancy. Obs. Gynecol. 1991, 77, 841–845. [Google Scholar]
- Sanz-Salvador, L.; García-Pérez, M.Á.; Tarín, J.J.; Cano, A. Bone metabolic changes during pregnancy: A period of vulnerability to osteoporosis and fracture. Eur. J. Endocrinol. 2015, 172, R53–R65. [Google Scholar] [CrossRef]
- Kuroda, T.; Nagai, T.; Ishikawa, K.; Inagaki, K. Clinical features and diagnosis of lumbar fractures caused by pregnancy and lactation-associated osteoporosis. Clin. Calcium. 2019, 29, 46–50. [Google Scholar]
- Kaur, M.; Pearson, D.; Godber, I.; Lawson, N.; Baker, P.; Hosking, D. Longitudinal changes in bone mineral density during normal pregnancy. Bone 2003, 32, 449–454. [Google Scholar] [CrossRef]
- Ulrich, U.; Miller, P.B.; Eyre, D.R.; Chesnut, C.H., III; Schlebusch, H.; Soules, M.R. Bone remodeling and bone mineral density during pregnancy. Arch. Gynecol. Obs. 2003, 268, 309–316. [Google Scholar] [CrossRef]
- Naylor, K.E.; Iqbal, P.; Fledelius, C.; Fraser, R.B.; Eastell, R. The effect of pregnancy on bone density and bone turnover. J. Bone Min. Res. 2000, 15, 129–137. [Google Scholar] [CrossRef]
- Aj, B.; Topping, J.; Durham, B.; Rg, F.; Wd, F. A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J. Bone Min. Res. 2000, 15, 557–563. [Google Scholar] [CrossRef]
- Pabinger, C.; Heu, C.; Frohner, A.; Dimai, H.P. Pregnancy and lactation-associated transient osteoporosis of both hips in a 32 year old patient with osteogenesis imperfecta. Bone 2012, 51, 142–144. [Google Scholar] [CrossRef] [PubMed]
- Nordin, B.E.; Roper, A. Post-pregnancy osteoporosis; a syndrome? Lancet 1955, 268, 431–434. [Google Scholar] [CrossRef]
- Basma, H.; Dbouk, S.; Issa, Z. Pregnancy and Lactation Associated Osteoporosis: A Case Report. Front. Med. Case Rep. 2023, 4, 1–8. [Google Scholar] [CrossRef]
- Karlsson, M.K.; Ahlborg, H.G.; Karlsson, C. Maternity and bone mineral density. Acta Orthop. 2005, 76, 2–13. [Google Scholar] [CrossRef] [PubMed]
- Butscheidt, S.; Tsourdi, E.; Rolvien, T.; Delsmann, A.; Stürznickel, J.; Barvencik, F.; Jakob, F.; Hofbauer, L.C.; Mundlos, S.; Kornak, U.; et al. Relevant genetic variants are common in women with pregnancy and lactation-associated osteoporosis (PLO) and predispose to more severe clinical manifestations. Bone 2021, 147, 115911. [Google Scholar]
- Toussia-Cohen, S.; Eshed, I.; Segal, O.; Schonfeld, M.; Meyer, R.; Axelrod, M.; Gat, I.; Dulitzky, M. Transient osteoporosis of the hip in pregnancy—A case series. J. Matern. Fetal Neonatal. Med. 2023, 36, 2175659. [Google Scholar] [CrossRef] [PubMed]
- Qian, Y.; Wang, L.; Yu, L.; Huang, W. Pregnancy- and lactation-associated osteoporosis with vertebral fractures: A systematic review. BMC Musculoskelet. Disord. 2021, 22, 926. [Google Scholar]
- Siris, E.S.; Chen, Y.-T.; Abbott, T.A.; Barrett-Connor, E.; Miller, P.D.; Wehren, L.E.; Berger, M.L. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch. Intern. Med. 2004, 164, 1108–1112. [Google Scholar] [CrossRef] [PubMed]
- Toba, M.; Terauchi, M.; Moriwaki, M.; Obayashi, S.; Miyasaka, N.; Fushimi, K. Fractures within 2 years of an obstetric hospitalization: Analysis of nationwide administrative data in Japan. J. Bone Min. Metab. 2022, 40, 748–754. [Google Scholar] [CrossRef]
- Aibar-Almazán, A.; Voltes-Martínez, A.; Castellote-Caballero, Y.; Afanador-Restrepo, D.F.; Carcelén-Fraile, M.D.C.; López-Ruiz, E. Current Status of the Diagnosis and Management of Osteoporosis. Int. J. Mol. Sci. 2022, 23, 9465. [Google Scholar] [CrossRef]
- Saad, R.K.; Ghezzawi, M.; Habli, D.; Alami, R.S.; Chakhtoura, M. Fracture risk following bariatric surgery: A systematic review and meta-analysis. Osteoporos. Int. 2022, 33, 511–526. [Google Scholar]
- Iio, K.; Kondo, E.; Shibata, E.; Wada, T.; Uchimura, T.; Kinjo, Y.; Murakam, M.; Yoshino, K. Long-Term Tocolysis With Magnesium Sulfate as a Risk Factor for Low Bone Mass: A Case Series. J. Med. Cases. 2022, 13, 47. [Google Scholar] [PubMed]
- Carsote, M.; Turturea, M.R.; Valea, A.; Buescu, C.; Nistor, C.; Turturea, I.F. Bridging the Gap: Pregnancy-And Lactation-Associated Osteoporosis. Diagnostics 2023, 13, 1615. [Google Scholar] [CrossRef] [PubMed]
- Kadam, N.; Chiplonkar, S.; Khadilkar, A.; Khadilkar, V. Low knowledge of osteoporosis and its risk factors in urban Indian adults from Pune city, India. Public Health Nutr. 2019, 22, 1–8. [Google Scholar]
- Yang, Y.; Wang, S.; Cong, H. Association between parity and bone mineral density in postmenopausal women. BMC Women’s Health 2022, 22, 87. [Google Scholar] [CrossRef] [PubMed]
- Seo, E.; Lee, Y.; Kim, H.C. Association Between Parity and Low Bone Density Among Postmenopausal Korean Women. J. Prev. Med. Public Health 2021, 54, 284–292. [Google Scholar] [PubMed]
- Ishida, T.; Yuri, H.; Nakamura, E.; Isoda, K.; Wada, Y.; Kotani, T.; Takeuchi, T. Low pre-pregnant body mass index is a risk factor for the decrease of postpartum bone mineral density in systemic lupus erythematosus patients received glucocorticoid therapy. Lupus 2022, 31, 848–854. [Google Scholar] [PubMed]
- Naumburg, E.; Bellocco, R.; Cnattingius, S.; Hall, P.; Boice, J.D., Jr.; Ekbom, A. Intrauterine exposure to diagnostic X-rays and risk of childhood leukemia subtypes. Radiat. Res. 2001, 156, 718–723. [Google Scholar] [CrossRef]
- North, D.L. Radiation doses in pregnant women. J. Am. Coll. Surg. 2002, 194, 100–101. [Google Scholar] [CrossRef] [PubMed]
- Melnick, D.M.; Wahl, W.; Dalton, V.K. Management of general surgical problems in the pregnant patient. Am J Surg. 2004, 187, 170–180. [Google Scholar] [CrossRef]
- Hart, M.A. Help! My orthopaedic patient is pregnant! Orthop. Nurs. 2005, 24, 108–114. [Google Scholar] [CrossRef]
- Mazze, R.; Kallen, B. Reproductive outcome after anesthesia and operation during pregnancy: A registry study of 5405 cases. Am. J. Obs. Gynecol. 1989, 161, 1178–1185. [Google Scholar] [CrossRef] [PubMed]
- Rees, G.A.; Willis, B.A. Resuscitation in late pregnancy. Anaesthesia 1988, 43, 347–349. [Google Scholar] [CrossRef] [PubMed]
- Kloen, P.; Flik, K.; Helfet, D.L. Operative treatment of acetabular fracture during pregnancy: A case report. Arch. Orthop. Trauma Surg. 2005, 125, 209–212. [Google Scholar] [CrossRef]
- Kuczkowski, K. Nonobstetric surgery during pregnancy: What are the risks of anesthesia? Obs. Gynecol. Surv. 2003, 59, 52–56. [Google Scholar] [CrossRef] [PubMed]
- Horrigan, T.J.; Villarreal, R.; Weinstein, L. Are obstetrical personnel required for intraoperative fetal monitoring during nonobstetric surgery? J. Perinatol. 1999, 19, 124–126. [Google Scholar] [CrossRef]
- Labronici, P.J.; Lyra, F.S.; Moreira, I.L., Jr.; Hoffmann, R.; Franco, J.S.; de Toledo Lourenço, P.R.; Labronici, G.J. Fractures of the distal extremity of the tibia treated with intramedullary nail or bridge plate: Comparison of radiation exposure between the two methods. Rev. Bras. Ortop. 2010, 45, 132–135. [Google Scholar] [CrossRef]
- Porter, S.E.; Russell, G.V.; Qin, Z.; Graves, M.L. Operative fixation of acetabular fractures in the pregnant patient. J. Orthop. Trauma 2008, 22, 508–516. [Google Scholar] [CrossRef]
- Pombo, A.; Guimares, H.; Araujo, A.M.; Nunes, C.S.; Cabido, H.; Lemos, P. Anesthesia and Postoperative Analgesia for Cesarean Section: A Retrospective Observational Study. J. Obstet. Anaesth. Crit. Care 2025, 15, 53–58. [Google Scholar] [CrossRef]
- Robertson, L.; Greer, I. Thromboembolism in pregnancy. Curr. Opin. Obs. Gynecol. 2005, 17, 113–116. [Google Scholar] [CrossRef] [PubMed]
- Zee, A.A.; van Lieshout, K.; van der Heide, M.; Janssen, L.; Janzing, H.M. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization. Cochrane Database Syst. Rev. 2017, 8, CD006681. [Google Scholar] [CrossRef] [PubMed]
- Niccolai, C.S.; Hicks, R.W.; Oertel, L.; Francis, J.L.; Heparin Consensus Group. Unfractionated heparin: Focus on high-alert drug. Pharmacotherapy 2004, 24, 146S–155S. [Google Scholar] [PubMed]
- Hawkins, D.; Evans, J. Minimising the risk of heparin-induced osteoporosis during pregnancy. Expert. Opin. Drug Saf. 2005, 4, 583–590. [Google Scholar] [CrossRef]
- McRae, S.J.; Ginsberg, J.S. Initial treatment of venous thromboembolism. Circulation 2004, 110 (Suppl. SI), I3–I9. [Google Scholar] [CrossRef] [PubMed]
- Soeiro, A.M.; Silva, P.G.; Roque, E.A.; Bossa, A.S.; César, M.C.; Simões, S.A.; Okada, M.Y.; Leal, T.C.; Pedroti, F.C.; Oliveira, M.T., Jr. Fondaparinux versus Enoxaparin—Which is the Best Anticoagulant for Acute Coronary Syndrome?—Brazilian Registry Data. Arq. Bras. Cardiol. 2016, 107, 239–244. [Google Scholar] [CrossRef] [PubMed]
- Haddad, P.; Peng, J.; Drake, M.; Rahimi, M. Inferior Vena Cava Filters: An Overview. Methodist. Debakey Cardiovasc. J. 2024, 20, 49–56. [Google Scholar] [CrossRef]
- Visconti, L.; Celi, A.; Carrozzi, L.; Tinelli, C.; Crocetti, L.; Daviddi, F.; De Caterina, R.; Madonna, R.; Pancani, R. Inferior vena cava filters: Concept review and summary of current guidelines. Vasc. Pharmacol. 2024, 155, 107375. [Google Scholar] [CrossRef]
- Marron, R.M.; Rali, P.; Hountras, P.; Bull, T.M. Inferior Vena Cava Filters: Past, Present, and Future. Chest 2020, 158, 2579–2589. [Google Scholar]
- Degennaro, V.A.; Brandi, M.L.; Cagninelli, G.; Casciaro, S.; Ciardo, D.; Conversano, F.; Di Pasquo, E.; Gonnelli, S.; Lombardi, F.A.; Pisani, P.; et al. First assessment of bone mineral density in healthy pregnant women by means of Radiofrequency Echographic Multi Spectrometry (REMS) technology. Eur. J. Obs. Gynecol. Reprod. Biol. 2021, 263, 44–49. [Google Scholar] [CrossRef]
- Ramirez Zegarra, R.; Degennaro, V.; Brandi, M.L.; Cagninelli, G.; Casciaro, S.; Celora, G.; Conversano, F.; Lombardi, F.A.; Pisani, P.; Ghi, T. Longitudinal changes of the femoral bone mineral density from first to third trimester of pregnancy: Bone health assessment by means of non-ionizing REMS technology. Aging Clin. Exp. Res. 2024, 36, 31. [Google Scholar] [PubMed]
- Hedström, M. Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment?: A pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures. Acta Orthop. Scand. 2004, 75, 50–52. [Google Scholar] [PubMed]
- Wright, E.V.; Naqvi, A.Z.; Seyd, S.; Zaw, H. Transient osteoporosis of the hip in pregnancy: The orthopaedic management of bilateral neck of femur fractures in the third trimester. BMJ Case Rep. 2021, 14, e238659. [Google Scholar] [CrossRef] [PubMed]
Focus On | Recommended |
---|---|
Calcium |
|
Vitamin D |
|
Exercise |
|
Procedure | Fetal Exposure 1 rad = 0.01 Gy |
---|---|
Chest X-ray (anteroposterior/lateral) | 0.02–0.07 mrad |
Abdominal plain X-ray | 100 mrad |
Hip X-ray (single view) | 200 mrad |
Head or chest CT | <1 rad |
Abdomen and lumbar spine CT | 3.5 rad |
Pelvis CT | 0.25–1.5 rad |
Anteroposterior pelvis | 0.04 rad |
Complete spine series | 0.37 rad |
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Tîrnovanu, Ș.-D.; Cojocaru, E.; Veliceasa, B.; Forna, N.; Carp, A.-C.; Puha, B.; Filip, A.; Dmour, A.; Popescu, D.-C.; Alexa, O.; et al. Femoral Fracture in Pregnancy: A Case Report and Review of Data from the Literature. Life 2025, 15, 601. https://doi.org/10.3390/life15040601
Tîrnovanu Ș-D, Cojocaru E, Veliceasa B, Forna N, Carp A-C, Puha B, Filip A, Dmour A, Popescu D-C, Alexa O, et al. Femoral Fracture in Pregnancy: A Case Report and Review of Data from the Literature. Life. 2025; 15(4):601. https://doi.org/10.3390/life15040601
Chicago/Turabian StyleTîrnovanu, Ștefan-Dragoș, Elena Cojocaru, Bogdan Veliceasa, Norin Forna, Adrian-Claudiu Carp, Bogdan Puha, Alexandru Filip, Awad Dmour, Dragoș-Cristian Popescu, Ovidiu Alexa, and et al. 2025. "Femoral Fracture in Pregnancy: A Case Report and Review of Data from the Literature" Life 15, no. 4: 601. https://doi.org/10.3390/life15040601
APA StyleTîrnovanu, Ș.-D., Cojocaru, E., Veliceasa, B., Forna, N., Carp, A.-C., Puha, B., Filip, A., Dmour, A., Popescu, D.-C., Alexa, O., Anton, S.-C., & Tîrnovanu, M.-C. (2025). Femoral Fracture in Pregnancy: A Case Report and Review of Data from the Literature. Life, 15(4), 601. https://doi.org/10.3390/life15040601