Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Albright F, Reifenstein EC (1949) The parathyroid glands and metabolic bone disease. Selected studies. Am J Med 7:844

    Google Scholar 

  2. Nordin BE, Roper A (1955) Post-pregnancy osteoporosis: a syndrome? Lancet 268:431–434

    Article  CAS  PubMed  Google Scholar 

  3. Kovacs CS, Ralston SH (2015) Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int 26(9):2223–2241

    Article  CAS  PubMed  Google Scholar 

  4. Maliha G, Morgan J, Vrahas M (2012) Transient osteoporosis of pregnancy. Injury, Int J Care Injured 43:1237–1241

    Article  Google Scholar 

  5. Cakmak B, Ribeiro AP, Inanir A (2016) Postural balance and the risk of falling during pregnancy. J Matern Fetal Neonatal Med 29(10):1623–1625

    PubMed  Google Scholar 

  6. McCrory JL, Chambers AJ, Daftary A, Redfern MS (2010) Dynamic postural stability during advancing pregnancy. J Biomech 43:2434–2439

    Article  CAS  PubMed  Google Scholar 

  7. Sanz-Salvador L, Garcia-Perez MA, Tarin JJ, Cano A (2015) Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture. Eur J Endocrinol 172(2):R53–R65

    Article  CAS  PubMed  Google Scholar 

  8. More C, Bettembuk P, Bhattoa HP, Balogh A (2001) The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 12(9):732–737

    Article  CAS  PubMed  Google Scholar 

  9. Chatterjee S, Kotelchuck M, Sambamoorthi U (2008) Prevalence of chronic illness in pregnancy, access to care, and health care costs: implications for interconception care. Womens Health Issues 18(6):107–116

    Article  Google Scholar 

  10. Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ (2013) Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol 209(1):1–10

    Article  PubMed  Google Scholar 

  11. Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated osteoporosis: a case-control study. Osteoporos Int 28(4):1393–1399

    Article  CAS  PubMed  Google Scholar 

  12. Kovacs C (2016) Maternal mineral and bone metabolism during pregnancy, lactation and post-weaning recovery. Physiol Rev 96(2):449–547

    Article  CAS  PubMed  Google Scholar 

  13. Schiff MA (2008) Pregnancy outcomes following hospitalisation for a fall in Washington state from 1987–2004. BJOG 115:1648–1654

    Article  CAS  PubMed  Google Scholar 

  14. Cannada LK, Pan P, Casey BM, McIntire DD, Shafi S, Leveno KJ (2010) Pregnancy outcomes after orthopedic trauma. J Trauma 69:694–698

    Article  PubMed  Google Scholar 

  15. Dunning K, LeMasters G, Bhattacharya A (2010) A major public health issue: the high incidence of falls during pregnancy. Matern Child Health J 14:720–725

    Article  PubMed  Google Scholar 

  16. Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM, Hay SM, Hosking DJ, Purdie DW, Ralston SH, Reeve J, Russell RGG, Stevenson JC (2001) Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action? Q J Med 94:575–597

    Article  CAS  Google Scholar 

  17. Pritchard JM, Giangregorio LM, Ioannidis G, Papaioannou A, Adachi JD, Leslie WD (2012) Ankle fractures do not predict osteoporotic fractures in women with or without fractures. Osteoporos Int 23:957–962

    Article  CAS  PubMed  Google Scholar 

  18. Biver E, Durosier C, Chevalley T, Hermann FR, Ferrari S, Rizzoli R (2015) Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations. Osteoporos Int 26:2147–2155

    Article  CAS  PubMed  Google Scholar 

  19. Stein EM, Liu XS, Nickolas TL, Cohen A, Thomas V, McMahon DJ, Zhang C, Cosman F, Nieves J, Greisberg J, Guo XE, Shane E (2011) Abnormal microarchitecture and stiffness in postmenopausal women with ankle fractures. J Clin Endocrinol Metabol 96(7):2041–2048

    Article  CAS  Google Scholar 

  20. Shahtaheri SM, Aaron JE, Johnson DR, Purdie DW (1999) Changes in trabecular bone architecture in women during pregnancy. Br J Obstet Gynaecol 106(5):432–438

    Article  CAS  PubMed  Google Scholar 

  21. Wisser J, Florio I, Neff M, Konig V, Huch R, Huch A, Mandach UV (2005) Changes in bone density and metabolism in pregnancy. Acta Obstet Gynecol Scand 84:349–354

    Article  PubMed  Google Scholar 

  22. Ulrich U, Miller PB, Eyre DR, Chesnut CH, Schlebusch H, Soues MR (2003) Bone remodelling and bone mineral density during pregnancy. Arch Gynecol Obstet 268:309–316

    Article  CAS  PubMed  Google Scholar 

  23. Styczynska H, Lis K, Sobanska I, Pater A, Pollak J, Mankowska A (2009) Bone turnover markers and osteoprotegerin in uncomplicated pregnancy. Electron J Int Fed Clin Chem Lab Med 19(4):193–202

    Google Scholar 

  24. Dieguez M, Herrero A, Avello N, Suarez P, Delgado E, Menendez E (2016) Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age? Clin Endocrinol 84(1):121–126

    Article  CAS  Google Scholar 

  25. Negro R, H MJ (2011) Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab 25(6):927–943

    Article  CAS  PubMed  Google Scholar 

  26. Walsh JP (2016) Managing thyroid disease in general practice. Med J Aust 205(4):179–184

    Article  PubMed  Google Scholar 

  27. World Health Organization (2016) Diabetes country profiles 2016—Australia, Geneva

  28. Australian Bureau of Statistics (2015) National health survey: first results, 2014–15. Cat. No. 4363.0.55.001;. ABS, Canberra

  29. Templeton M, Pieris-Caldwell I (2008) Gestational diabetes mellitus in Australia, 2005-06. Cat. no. CVD 44. Australian Institute of Health and Welfare

  30. Australian Institute of Health and Welfare (2016) Australia’s mothers and babies 2014: in brief. Perinatal statistics series no. 32 Cat no. PER 87. AIHW, Canberra

  31. Greenfield DM, Eastell R (2001) Risk factors for ankle fracture. Osteoporos Int 12:97–103

    Article  CAS  PubMed  Google Scholar 

  32. Baldwin EA, Borowski KS, Brost BC, Rose CH (2015) Antepartum nonobstetrical surgery at >/= 23 weeks’ gestation and risk for preterm delivery. Am J Obstet Gynecol 212(232):e1–e5

    Google Scholar 

  33. Bhattee G, Rahman MS, Rahman J (2009) Open reduction and internal fixation of an acetabular fracture in pregnancy: a case report. Curr Orthop Pract 20(3):329–330

    Article  Google Scholar 

  34. American College of Obstetricians and Gynecologists (2017) Nonobstetric surgery during pregnancy. Committee Opinion No. 696. Obstet Gynecol 129:777–778

    Article  Google Scholar 

  35. Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11:449–454

    Article  CAS  PubMed  Google Scholar 

  36. Salles JP (2016) Bone metabolism during pregnancy. Ann Endocrinol 77:163–168

    Article  Google Scholar 

  37. Pediatrics AAo (2012) Breastfeeding and the use of human milk. Pediatrics 129(3):e827–e841

    Article  Google Scholar 

  38. Patlas N, Golomb G, Yaffe P, Pinto T, Breuer E, Ornoy A (1999) Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats. Teratology 60:68–73

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

A.T. is supported by a Royal Australasian College of Physicians/Osteoporosis Australia research grant. F.M. and P.W. are supported by an Osteoporosis Australia/Australia and New Zealand Bone and Mineral Society clinical grant. Hudson Institute is supported by the Victorian government’s Operational Infrastructure Support program.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Monash Health, Clayton, VIC, Australia

    Madhuni Herath, Phillip Wong, Anne Trinh, Carolyn A. Allan, Peter R. Ebeling, Peter J. Fuller & Frances Milat

  2. Hudson Institute of Medical Research, Clayton, VIC, Australia

    Madhuni Herath, Phillip Wong, Anne Trinh, Carolyn A. Allan, Peter J. Fuller & Frances Milat

  3. Department of Medicine, Monash University, Melbourne, VIC, Australia

    Phillip Wong, Anne Trinh, Peter R. Ebeling & Frances Milat

  4. Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia

    Carolyn A. Allan

  5. Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia

    Euan M. Wallace

  6. Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, VIC, Australia

    Euan M. Wallace

Authors
  1. Madhuni Herath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Phillip Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Trinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carolyn A. Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Euan M. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter R. Ebeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter J. Fuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frances Milat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frances Milat.

Ethics declarations

Ethics approval was obtained from the Monash Health Human Research Ethics Committee.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Herath, M., Wong, P., Trinh, A. et al. Minimal-trauma ankle fractures predominate during pregnancy: a 17-year retrospective study. Arch Osteoporos 12, 86 (2017). https://doi.org/10.1007/s11657-017-0380-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-017-0380-x

Keywords

Search

Navigation