A Rare Clinical Dilemma: Humeral Shaft Fracture in a Full-Term Pregnant Patient - A Case Report with Review of Literature.

INTRODUCTION: Orthopedic trauma complicates 6-7% of pregnancies and remains a leading cause of non-obstetric maternal and fetal morbidity. While musculoskeletal injuries during pregnancy are not uncommon, fractures requiring surgical intervention in the third trimester are rare and present unique management challenges. Among these, humeral shaft fractures are especially rare, and their management must carefully balance maternal recovery with fetal well-being.

CASE REPORT: We report the case of a 30-year-old primigravida at 38 + 4 weeks of gestation who sustained a left diaphyseal humerus fracture following a motor vehicle collision. Initial management included closed reduction and immobilization in a U-arm slab. Due to signs of fetal distress on cardiotocography and Doppler ultrasound - suggestive of intrauterine hypoxia - an emergency lower segment cesarean section was performed under spinal anesthesia. Four days postpartum, the patient underwent successful open reduction and internal fixation of the humerus using an extra-articular distal humerus plate and lag screws. A combined general anesthesia and supraclavicular brachial plexus block provided effective perioperative pain management. Post-operative recovery was uneventful, with early mobilization and favorable maternal and neonatal outcomes.

CONCLUSION: This case underscores the importance of a multidisciplinary, staged approach to orthopedic trauma in late pregnancy. Prioritizing timely obstetric intervention followed by delayed fracture fixation allows safe maternal recovery while safeguarding fetal health.