Posted: Apr 27 2021 #(C101751)

Midshaft Clavicle Fracture in 16M

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HPI

A 16 year old male presents to the ED after a mountain bike accident. Upon presentation he had isolated pain to his right shoulder. Denies head trauma or loss of conciousness. No other injuries. Denies any numbness or tingling of the right arm or hand.

PMH

None

Focused examination of the right upper extremity demonstrates gross deformity at the mid clavicle with skin intact. Evidence of skin tenting. He is neurovascularly intact.

Poll

1 of 11

In addition to plain film clavicle radiographs, would you obtain any additional imaging to guide treatment?

1 No - current radiographs are sufficient

2 Yes - additional radiographic views (XR)

3 Yes - CT scan of the shoulder (CT)

4 Yes - MRI scan of the shoulder (MRI)

5 Yes - XR + CT

6 Yes - XR + MRI

7 Yes - CT + MRI

8 Yes - XR + CT + MRI

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

Other

Submit

P: 131320

Would you use a classification system to guide management?

1 No - a classification system would not help me

2 Yes - Neer Classification

3 Yes - AO/OTA classification

4 Yes - Other

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

Other

Submit

P: 131321

How would you manage this injury?

1 Nonoperative

2 Operative

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

Other

Submit

P: 131322

If you choose Nonoperative management, what immobilization treatment would you choose?

1 I would not choose Nonoperative management

2 No immobilization

3 Sling

4 Figure-of-eight brace

5 Other

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

Other

Submit

P: 131323

If you choose Nonoperative management, what activity would you prescribe initially?

1 I would not choose Nonoperative management

2 Non-weight-bearing (NWB)

3 Partial-weight bearing (< 5-10 lbs, PWB)

4 Weight bearing as tolerated (WBAT)

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

Other

Submit

P: 131324

If you choose Operative management, what surgery would you perform?

1 I would not choose Operative management

2 Closed reduction with intramedullary implant

3 Open reduction with intramedullary fixation

4 Open reduction internal fixation with plate(s) and screws (ORIF)

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

Other

Submit

P: 131325

If you choose Operative management, how would you position the patient?

1 I would not choose Operative management

2 Beach chair with an arm holder

3 Radiolucent flat top with a plexi glass attachment

4 Regular bed with a hand table or radiolucent extension

5 Other

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

Other

Submit

P: 131326

If you choose Open reduction and internal fixation (ORIF) with plate(s) and screws, how would you manage the supraclavicular nerve?

1 I would not choose ORIF with plate(s) and screws

2 Preserve all branches of the supraclavicular nerve

3 Preserve one or more branches of the supraclavicular nerve

4 Preserve no branches of the supraclavicular nerve

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

Other

Submit

P: 131327

If you choose Open reduction and internal fixation (ORIF) with plate(s) and screws, what construct would you select?

1 I would not choose ORIF with plate(s) and screws

2 Superior plating

3 Anterior plating

4 Dual (90-90, anterior + superior) plating

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

Other

Submit

P: 131328

If you choose Operative management and attained the construct shown below, how would you manage post-operative weight-bearing?

1 I would not choose Operative management

2 Non-weight-bearing (NWB)

3 Partial weight bearing < 5-10 lbs

4 Weight bearing as tolerated

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

Other

Submit

P: 131410

Post-procedure P1

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