Posted: Feb 20 2022 #(C102006)

Transolecranon Fx/Dislocation with Ipsilateral Distal Radius Fx in 38F

HPI

A 38-year-old female was involved in an MVC and injured her right arm. She states that her right arm struck the dashboard during the collision. She immediately felt pain and was unable to use her arm afterward. She has been transferred to your hospital for further evaluation. She denies any pain in any other extremity. She denies any head trauma or loss of consciousness.

PMH

No significant past medical history. Urine pregnancy test is negative

A focused physical exam reveals swelling and deformity present over the right elbow and wrist. Skin is intact with no active bleeding. There is pain with the attempted range of motion of the elbow and the wrist. Tenderness to palpation is present over the elbow, forearm, and wrist. Motor and sensation are present in all peripheral nerve distributions. Pulses are present and palpable.

Poll

1 of 12

1. In addition to plain radiographs, would you obtain any further imaging to guide your treatment?

No - current radiographs are sufficient

14%

111/776

Yes - additional radiographic views (i.e traction views, aXR)

19/776

Yes - CT scan (CT)

73%

574/776

Yes - MRI

7/776

Yes - aXR + CT

43/776

Yes - aXR + MRI

2/776

Yes - CT + MRI

13/776

Yes - aXR + CT + MRI

2/776

Outside my area of expertise - best if I do not vote

5/776

2. Would you use a classification system to guide management?

No - a classification system would not help me

58%

445/761

Yes - AO/OTA

26%

201/761

Yes - Mayo

45/761

Yes - Colton

9/761

Yes - Schatzker

12/761

Yes - Other

16/761

Outside my area of expertise - best if I don't vote

33/761

3. How would you definitively manage this patient?

Nonoperative

4/765

Operative

98%

756/765

Outside my area of expertise - best if I don't vote

5/765

4. If you choose Operative management, which fractures would you fix and in what order?

I would not choose Operative management

0/760

Olecranon only

7/760

Distal radius only

3/760

Both - Olecranon first, then Distal radius

77%

587/760

Both - Distal radius first, then Olecranon

20%

154/760

Outside my area of expertise - best if I don't vote

9/760

5. If you choose Operative management, considering the patient presented to the ER at 2 PM on a weekday on the day of injury, what would be your time frame to take him to surgery and where would you do it?

I would not choose Operative Management

1/758

Admit to hospital - perform surgery Same day

34%

260/758

Admit to hospital - perform surgery Next day

49%

374/758

Discharge - operate at Hospital - within 5 days

53/758

Discharge - operate at Hospital - within 10 days

16/758

Discharge - operate at Hospital - no time limit

0/758

Discharge - operate at Surgery Center - within 5 days

29/758

Discharge - operate at Surgery Center - within 10 days

16/758

Discharge - operate at Surgery Center - no time limit

0/758

Outside my area of expertise - best if I don't vote

9/758

6. If you choose Operative management for the olecranon fracture, what surgery would you perform?

I would not choose Operative management for the olecranon fracture

0/748

External fixation only (includes monoplanar, ringed circular fixation, etc.)

2/748

Closed reduction percutaneous pinning (CRPP) only

9/748

Open reduction and internal fixation (ORIF)

96%

723/748

Fragment excision with triceps advancement

1/748

Arthroplasty

1/748

Outside my area of expertise - best if I don't vote

12/748

7. If you choose Open reduction internal fixation (ORIF) for the olecranon fracture, which technique would you utilize?

I would not choose ORIF for the olecranon fracture

1/737

Tension band (i.e wires, suture)

47/737

Plate(s) and screw(s)

91%

675/737

Intramedullary nail (IMN)

3/737

Outside my area of expertise - best if I don't vote t

11/737

8. If you choose Operative management for the distal radius fracture, what surgical technique would you use?

I would not choose Operative management

1/726

External fixation (ExFix) (includes monoplane, circular fixation)

1/726

External fixation with limited internal fixation

14/726

Open reduction and internal fixation (ORIF) only

84%

616/726

Closed reduction percutaneous pinning (CRPP) only

17/726

ORIF + CRPP

70/726

Outside my area of expertise - best if I don't vote

7/726

9. If you choose Open reduction and internal fixation (ORIF) for the distal radius fracture, what approach would you use?

I would not choose ORIF for the distal radius fracture

4/720

Volar only

83%

603/720

Dorsal only

18/720

Volar + Dorsal

43/720

Volar + Radial

28/720

Dorsal + Radial

7/720

Volar + Dorsal + Radial

6/720

Outside my area of expertise - best if I don't vote

11/720

10. If you choose Operative management and attained the construct shown, when would you allow weight-bearing post-operatively?

I would not choose Operative management

1/660

Immediately

25/660

1-2 weeks

47/660

3-4 weeks

15%

99/660

5-6 weeks

43%

287/660

7-8 weeks

20%

133/660

9-10 weeks

19/660

11-12 weeks

20/660

>12 weeks

19/660

Outside my area of expertise – best if I don’t vote

10/660

11. If you choose Operative management and attained the construct shown below, when would you allow full active motion of the elbow?

I would not choose Operative management for the olecranon fracture

1/691

Immediately

24%

167/691

< 2 weeks

22%

153/691

2-3 weeks

27%

187/691

4-5 weeks

13%

92/691

6-7 weeks

53/691

7-8 weeks

16/691

> 8 weeks

16/691

Outside my area of expertise – best if I don’t vote

6/691

12. If you choose Operative management and attained the construct shown below, would you treat with heterotopic ossification (HO) prophylaxis?

I would not choose Operative management of the olecranon fracture

3/677

No - I would not recommend HO prophylaxis

56%

382/677

Yes - Indomethacin Orally

38%

259/677

Yes - Radiation

5/677

Outside of my area of expertise - best I don't answer

28/677

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