Surgical Management of Ankle Fracture in Late Pregnancy: A Case Report

Surgical management of ankle fractures during late pregnancy is rare and presents a unique challenge. We report the case of a 40-year-old woman at 30 weeks of gestation who sustained an unstable trimalleolar ankle fracture and was successfully treated with surgery without the need for immediate cesarean section. The fracture surgery was performed under combined spinal and epidural anesthesia with continuous fetal heart monitoring. The patient was placed in the left lateral decubitus position to avoid inferior vena cava compression. Low-dose fluoroscopy with abdominal shielding minimized fetal radiation exposure. To prevent deep vein thrombosis, a tourniquet was not used, preoperative venous ultrasonography was conducted, and postoperative anticoagulation was administered. Acetaminophen was used for pain control to avoid the risk of fetal ductal constriction associated with nonsteroidal anti-inflammatory drugs. Postoperative rehabilitation focused on safe mobilization while minimizing intra-abdominal pressure. This case highlights the importance of a multidisciplinary team approach in managing orthopedic surgeries during late pregnancy to achieve both maternal fracture healing and full-term vaginal delivery of the fetus.