Bone Fracture

INFORMATION FOR WOMEN WHO HAVE A BONE FRACTURE DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is a bone fracture?

A bone fracture is literally a crack in any bone in your body, but fractures range in severity, healing time, and in terms of the complications that can develop, depending on the shape and nature of the crack and where its located. A greenstick fracture, which occurs mostly in young bones (as in children), is a simple crack that does not go all the way through the bone, but the unbroken bone is bent. There also are linear fractures, consisting of a crack that runs along part of the bone, the long way, so it also does not go from one side to the other. There can be a transverse fracture, which is a crack going directly across the width of the bone, and an oblique fracture, which also runs across the bone width but at an angle. These types of fractures can occur without any shifting in the position between the parts of the bone on the two sides of the crack, in which case it is called a non-displaced fracture. A non-displaced fracture occurring outside of the joints (along the main length of the bone, for instance) is typically the simplest type of fracture to treat and heals the easiest. Fractures with more complex shapes, such as a spiral shape, fractures in which the separated parts of the bone are displaced (shifted with respect to one another), fractures in which the bones are splintered into several pieces (called comminuted fractures), and fractures inside a joint region (the area across the ends of two bones where various tendons and ligaments are attached, and often there is an enclosed cavity containing fluid) take longer and typically require more effort to heal. A fracture also is classified based on whether or not it is a compound (also called open) fracture, which means that the broken bone pushes out through the skin, and whether or not it is reducible, meaning that any displaced parts of the bones can be put back into place and will stay in place, without surgery and the use of hardware, such as screws and plates.

How common are bone fractures during pregnancy?

Based on a large study analyzing reports of thousands of fractures in a particular county in the United States between the years 2009 -2011, the rate of fractures of any type in any body part has been calculated at 2,704 per 100,000 person-years, meaning thats approximately the number of fractures that could be expected in a population of 100,000 people over one year, in 10,000 people over ten years, in 1,000 people over one hundred years, and so-on. Person-years are used because one person can suffer multiple fractures in different bones over the course of a lifetime. By looking at numbers from other research conducted further back into the past, the study also found that the number of fractures was on the rise during the middle to late 20th century for both men and women but has since leveled off. The fracture rate is higher in elderly people compared with younger adults, including pregnant women. Nevertheless, women are at particular risk for bone fractures during pregnancy, because of hormonal changes that function to keep calcium flowing from the mother, through the placenta, into the developing baby. While this is vital for the development of the baby’s bones, the effect can leave the mother with a kind of pregnancy-induced osteoporosis, a decrease in the density of bone mineral. Adding the fact that a woman also can be prone to falling toward the end of pregnancy as her weight increases and shifts, the possibility of a fracture during pregnancy is very real.    

How is a bone fracture diagnosed?

Usually, a simple X-ray scan taken from one angle, or sometimes from two angles, is all that is needed. Despite fears that are present in society concerning ionizing radiation, especially in connection with pregnancy, there is no danger from a simple X-ray scan, even during the early period of pregnancy when the developing baby is most vulnerable to radiation damage because the dosage of X-rays is orders of magnitude below the danger zone. This includes when the fracture could be in the hip or lower spine when the X-ray beam can pass through the womb. It is absolutely safe, and you should never avoid having a scan when you may have a fracture, whereas failing to have a fracture diagnosed can bring real danger. In the case of certain very severe fractures when there can be complex issues involving the geometry of the fracture or multiple fractures, the orthopedic surgeon may want a computed tomography (CT) scan of the traumatized site. This type of scan provides a much higher X-ray dosage, which could be in the range that is at least debated in terms of safety to a developing baby. However, if you are in this situation, it generally means that there could be severe, or complex, trauma, in which case the benefit of having the CT scan will outweigh the risks.

Does a bone fracture cause problems during pregnancy?

Fracture of a limb, hand, or foot, can be debilitating, particularly with the lower extremity, since pregnancy can make it harder to learn to use crutches. Fracture in the pelvis could be associated with injury to the womb, while fracture in the spine, hip, as well as the pelvis could be especially debilitating as to keep you confined to bed.

Does a bone fracture during pregnancy cause problems for the baby?

The fracture does not cause direct problems for the baby, but, as mentioned above, a fracture occurring near the womb (such as in the pelvis) could be associated with womb trauma. Furthermore, if the fracture is in the pelvis, vaginal delivery might not be possible, in which case a cesarean section would be needed.

What to consider about taking medications when you are pregnant:

  • The risks to yourself and your baby if you do not treat the bone fracture
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat my bone fracture during pregnancy?

In the course of treating fractures, medications are given to combat pain and inflammation. One group of medications that work against pain, but not inflammation, consists of acetaminophen in the United States and paracetamol in several other countries. Another group is called non-steroidal anti-inflammatory drugs (NSAIDs). These drugs work against both pain and inflammation and include ibuprofen, naproxen, and many others. Another group of medications, called salicylates, includes aspirin, which technically is also a kind of NSAID, because it reduces inflammation. There is concern that NSAIDs and salicylates may be harmful to the developing baby, especially early and late in pregnancy, but acetaminophen and paracetamol are thought to be safe. When these categories of drugs are not enough against the pain, for instance during and after surgery and possibly to fight pain during an external reduction (when the surgeon sets the fracture by manipulating the bone from the outside without surgery), stronger pain relievers will be needed. The stronger pain relievers are in a group of drugs called opioids or narcotics. In 2014, it was revealed that about 14 percent of pregnant women were taking opioids for various reasons. This has been a concern because there is evidence that long-term use of these drugs can lead to birth defects. However, when given for short periods, such as for a couple of days while you are recovering from surgery to
repair a fracture, its very difficult to design studies able to reveal whether or not the developing baby could be in danger.

Another type of medication that you may need, particularly if you suffer a compound fracture, is an antibiotic drug. There are numerous drugs that can be used with great variation in risks to the developing baby, so your doctor can select an antibiotic that is safe during pregnancy.

Who should NOT stop taking medication for a bone fracture during pregnancy?

If you need medication for pain, you should take something. It is always best to wean from an opioid to another type of drug, such as acetaminophen.

What should I know about choosing a medication for my bone fracture during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat bone fracture pain here and infections here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my bone fracture when I am breastfeeding?

Particular antibiotics can be selected that are considered safe during breastfeeding. There is increasing concern that opioids could be harmful during breastfeeding, so if you need these drugs you should consider refraining from breastfeeding, and use infant formula instead, at least until you stop the opioid. Acetaminophen, paracetamol, and NSAIDs are thought to be relatively safe in mothers who breastfeed.

What alternative therapies besides medications can I use to treat my bone fracture during pregnancy?

The principal treatment for a bone fracture is to reduce (set) the fracture (move separated parts of bones into correct alignment), if it is a displaced fracture and can be reduced without surgery. Non-displaced fractures and displaced fractures that have been set then have to heal. Often this means immobilizing one or more joints with a cast or splint. More complicated fractures require surgery. In all cases, medication is not the treatment, but is supportive, namely to combat pain and to prevent or treat infection.

What can I do for myself and my baby when I have a bone fracture during pregnancy?

Rest and keep weight off of the affected area as directed by your doctor.

Resources for bone fractures in pregnancy:

For more information about bone fractures during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

 

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Last Updated: 11-02-2020
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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