Minimal-trauma ankle fractures predominate during pregnancy: a 17-year retrospective study

Abstract: Summary: This study assessed all fractures occurring in pregnancy at a tertiary referral centre over a 17-year period. Most fractures were due to minimal trauma, and those involving the ankle were the most common. Women tended to fracture during their second and third trimesters and most required surgical intervention during pregnancy. Purpose: To characterise fractures in pregnancy over a 17-year period at a tertiary referral health service. Methods: Medical records at the Monash Health in Australia were examined from 2000–2016 for fractures in pregnancy using the birthing outcome system database and the tenth revision of the International Statistical Classification of Diseases and Related Health Problems coding. Site, mechanism, investigations, management and outcomes were documented. Results: Of the 114,673 live births during this period, 33 women (mean age 30.3 ± 1.9 years) were identified with fracture in pregnancy (~ 2.9 maternal fractures/10,000 live births). Minimal-trauma fractures (MTFs) occurred in 28 women whilst 5 were due to motor vehicle accidents. Of the MTF, 2/28 (7.1%), 13/28 (46.4%) and 13/28 (46.4%) occurred in the first, second and third trimesters, respectively. MTF involved the lower limb (60.7%), upper limb (25.0%), ribs (10.7%) and clavicle (3.6%). The ankle was involved in 39.3% of MTFs. Diabetes (14.3%), asthma (10.7%) and thyroid dysfunction (7.1%) affected these women with MTF; vitamin D levels were not routinely measured. Surgical interventions requiring anaesthesia were required in 57.1% with MTF: 50.0% during their second, 31.3% in their third and 12.5% in their first trimesters; 6.3% had surgery post partum. Pre-term birth and emergency caesarean section complicated 6/28 (21.4%) of MTF pregnancies. One patient received post-partum bisphosphonate therapy; only two 2/32 (6.25%) received medical follow-up. Conclusions: Fractures in pregnancy are uncommon. Lower limb fractures are frequently due to minimal trauma, and surgical intervention is often required. The low rate of medical follow-up in MTF is of concern and reinforces the need for greater recognition of potential osteoporosis in this population.