Management of a trochanteric fracture in progressive pregnancy in a precarious environment: A case report and literature review

Abstract

Pregnancy traumas are common, with an annual incidence between 5% and 8%. We report a case of right trochanteric fracture associated with a burn of the left lower limb in an eight-month pregnant woman treated at the Ziguinchor Regional hospital center in Senegal. A 23-year-old woman with no previous medical or surgical history was presented with right hip trauma and burns to the anterior aspect of left thigh. Occurred following the collapse of a kitchen built of clay. The patient had an 8-month, poorly followed, progressive pregnancy. X-rays showed a right inter-trochanteric fracture and a glimpse of the fetal head. Obstetrical ultrasound revealed an evolving intrauterine mono-fetal pregnancy of 36 weeks of gestation and 6 days. The patient was admitted for observation with glued traction of the fractured limb. On the 30th day of hospitalization, the patient developed a high fistula resulting in clear fluid loss, and delivered vaginally the following day with uncomplicated delivery. On the 48th day of hospitalization, she underwent DHS screw-plate hip surgery. Eight months after, the patient is walking independently. She complains of no pain and has good hip mobility. X-rays show bone consolidation and osteosynthesis material in place. Each step in the management of pregnancy trauma must be carefully codified and discussed according to the type of treatment, the age of the pregnancy and the vitality of the fetus, in order to avoid complications during pregnancy and childbirth, and any repercussions on the health of the newborn.