A 25-year-old female presented to orthopaedic OPD with complaints of right hip pain following a road traffic accident (High velocity injury). On arrival, she was hemodynamically stable and conscious. After taking a detailed record, we found that the patient was pregnant at 12 weeks of gestation. Doppler ultrasound confirmed normal foetal heart sounds.

The patient was determined to be stable after undergoing a primary survey. The patient complained of right hip pain during the secondary survey, also right lower limb shortening was noted (Figure 2). No neurovascular deficit was found. X-rays were avoided to prevent radiation exposure. MRI of the pelvis with hip joint revealed posterior right hip dislocation (Thompson and Epstein classification of posterior hip dislocation TYPE I) (Figure 3). Surgical management was deferred as the patient didn’t present with any absolute indication. After taking the Obstetrician opinion and informed consent from the patient, the patient underwent closed reduction by Rochester method (longitudinal traction and rotation control) under short GA. Range of motion and power at the right hip were checked post-reduction. The patient was mobilised with walker assistance on postoperative day 5. The physical examination of the right hip was painless and comfortable on regular follow-up, the patient has been advised to avoid extreme range of movements to avoid recurrence. The patient was further screened and evaluated, and the foetus was found to be safe and in no danger. Overall, the patient has recovered fully without any complications related to the hip. After three weeks of utilising a walking assistance following reduction, the patient was able to walk normally, and a healthy baby was delivered via normal delivery, according to additional follow-up.

Figure 2

It was found that around 46% of maternal deaths under 40 years of age are due to trauma in pregnant patients2, 3, 4, 5, 6 and it will lead to complicated pregnancy in about 6-7% of pregnant patients. 4. The incidence of road traffic accidents (RTA) in pregnant patients is about 55% 7. The incidence of maternal deaths in pregnant patients with RTA or trauma is about 10-11% and 10-15% are associated with the foetal death rate in the first trimester and 50-54% in the third trimester 8, 9. Every year around 1200 to 4000 pregnancies go for miscarriages due to trauma, with minor maternal injuries being the most important cause 10. Orthopaedic trauma is multiply injured and accounts for almost 22% 11. Pelvic fractures are highly prone to complications including foetal loss 12.

The pregnant patient with polytrauma comes with so much difficulty in management. In every step of management, the unique physiological change in pregnant patients demands some changes to standard trauma protocols.

This case showed various challenges encountered while managing the pregnant orthopaedic patient. With a panoramic, all-inclusive team effort, the patient was guided through closed reduction under short GA. In this case, both the mother and the foetus were diagnosed properly. The orthopaedic team skilfully treated the patient through the pre-and post-reduction span by achieving stable closed reduction and mobilizing the patient early also minimizing complications with the proper post-reduction rehabilitation. Overall, our case reveals that surgery can be avoided and successful closed reduction can be attained in pregnant patients who have undergone posterior dislocation of the hip with atypical presentation.