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INTRODUCTION: The occurrence of orthopedic injuries during pregnancy carries considerable morbidity and mortality for both the mother and fetus. Successful care of lower limb fractures during pregnancy requires a multidisciplinary approach. Both operative and non-operative treatments must be taken into account by the treating orthopedic physician. There is limited literature available on the management of these lower limb fractures in pregnancy, and peri-operative management of this obstetric and orthopedic trauma is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death, having a significant public health burden to both the mother and child. The aims and objectives of this study were to review the common causes of lower limb long bone trauma during pregnancy and their functional outcome in terms of morbidity and mortality. This study evaluates various operative and conservative methods of treatment to provide a comprehensive management approach to pregnant patients with lower limb trauma. MATERIALS AND METHODS: A prospective study on functional outcomes of 30 pregnant females who were admitted with lower limb long bone fractures from 2017 to 2021 was done. The patients were randomly selected intra-operatively for various procedures based on the surgeon's preference. All patients were followed for two years or till union occurred, and the radiographic union score for tibial (RUST) and modified radiographic union score for tibial (mRUST) fracture criteria were used to assess bony union clinico-radiologically. Results: During this study, the mean age of patients was 27 years (range 19-38), having right-side (53.33%) predominance with road traffic accidents (n=22) and falls (n=6) as the most common causes of injury. Two cases of domestic violence were also reported. In our study, the maximum number of cases was 17-25 weeks of their gestation; 12 (40%) patients had tibial fractures, and 18 (60%) had femoral fractures. Six tibial fractures were handled conservatively, while all femoral fractures required surgical intervention. Out of 18 femoral fractures, which were treated surgically, dynamic compression plating was done in 15 (83.33%) patients, while interlock nailing was done in three patients. Six tibial fractures have been operated upon, two (66.66%) with dynamic compression plating and four (33.33%) with an interlocking nail. CONCLUSION: A multidisciplinary approach in terms of both operative and non-operative methods must be taken into account for treating pregnant mothers by the orthopedic physician while carefully weighing the benefits and risks of both procedures. Based on the pattern and displacement of the fracture, many prenatal fractures can be treated conservatively. Another alternative that is frequently safe is to postpone the surgical procedure until childbirth. The physiologic changes associated with pregnancy and any potential dangers to the fetus must be taken into account by the orthopedic surgeon when fractures necessitate surgical intervention. The surgeon is responsible for the patient's correct placement, the C-arm's use, the radiation dose, and the intra-operative fetal monitoring, as well as the danger brought on by anesthetics, antibiotics, analgesics, and anticoagulants.
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BACKGROUND: Neuroanaesthesiologists are faced with managing and optimising the intracranial pressure in the perioperative period. Laryngoscopy and tracheal intubation are known to increase sympathetic activity that is well tolerated by healthy patients but may be detrimental to many comorbid patients. We, therefore, hypothesised that airway management and tracheal intubation through Ambu Aura-I (Ambu, Baltorpbakken 13, Denmark) may be associated with lesser changes in optic nerve sheath diameter (ONSD) compared to conventional tracheal intubation and designed a study to ultrasonographically measure the changes in optic nerve sheath diameter following tracheal intubation using Macintosh laryngoscope or fibreoptic-guided intubation through Ambu Aura-I in patients receiving endotracheal anaesthesia. MATERIAL AND METHODS: This randomised controlled hospital-based clinical study was conducted on 60 patients divided into two groups: group 1 (n=30, tracheal intubation facilitated by direct laryngoscopy with Macintosh laryngoscope) or group 2 (n=30, fibreoptic-guided tracheal intubation through Ambu Aura-I), undergoing elective surgery under general anaesthesia requiring tracheal intubation. RESULTS: Baseline parameters before induction of anaesthesia were recorded for further comparison. Baseline ONSD at 3 mm behind the globe in both eyes (before induction of anaesthesia), both in transverse and the coronal plane, was measured by transorbital sonography with the patient lying in the supine position using a portable Sonosite Turbo-M ultrasonography (Fujifilm Sonosite, Bothell, USA) machine. End-tidal carbon dioxide concentration (EtCO2) was also recorded at this time. Observations of HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), oxygen saturation (SpO2), EtCO2, and ONSD measurements were recorded immediately and at three and five minutes after intubation, and complications were recorded. Data collected were tabulated, and statistical analysis was done using SPSS 22.00 for windows (SPSS Inc, Chicago, USA). The ONSD increase peaked at 4.19±0.35 and 4.16±0.31 mm in right and left eyes. Like in group 1, the ONSD decreased slightly to 4.06±0,29 and 4.05±0.29 mm in right and left eyes in group 2 at 10 minutes after intubation. The changes in ONSD when compared to baseline values (before intubation) were statistically not significant (p>0.05). Between-group comparison in ONSD in both the eyes at different time intervals was statistically not significant (p>0.05). CONCLUSION: We conclude that fibreoptic-guided tracheal intubation through Ambu Aura-I is not superior to tracheal intubation using direct laryngoscopy with Macintosh laryngoscope in terms of its effect on intracranial pressure, as measured ultrasonographically by optic nerve sheath diameter.
