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HPI
A 22-year-old female, right-hand dominant, presented to the ED after being involved in an arm wrestling match where she noticed immediate pain and deformity of her right arm. She denied pain in her other extremities or any numbness or tingling to the right upper extremity. A reduction is performed by the emergency room physician and the patient is placed in a splint and post-reduction films taken.
PMH
There is no relevant past medical history.
PE
A focused physical examination of the right upper extremity showed obvious deformity with bony crepitus just proximal to the elbow without any open wounds. She had good pulses and a normal capillary refill. The compartments were soft and compressible. A careful exam of the median, ulnar, and radial nerve showed normal function and no deficits.
In addition to injury AP and LAT radiographs (without brace), would you obtain any additional imaging to guide your treatment?
No - Injury AP and LAT radiographs (without brace) are sufficient
59%
(524/883)
Yes - Additional radiographs (aXR) Alone (includes xrays in brace)
20%
(185/883)
Yes - CT scan (CT) Alone (includes 2D +/- 3D recons)
13%
(119/883)
Yes - MRI Alone
0%
(8/883)
Yes - aXR + CT
2%
(18/883)
Yes - aXR + MRI
0%
(2/883)
Yes - CT + MRI
0%
(3/883)
Yes - aXR + CT + MRI
0%
(1/883)
Other
0%
(2/883)
Outside my area of expertise - best if I don't vote
2%
(21/883)
How would describe this fracture pattern?
Spiral
78%
(749/950)
Short oblique
8%
(77/950)
Long oblique
11%
(105/950)
Other
0%
(7/950)
Outside my area of expertise - best if I do not vote
1%
(12/950)
If you choose Nonoperative management as definitive treatment, what technique would you choose?
I would not choose Nonoperative management
48%
(429/893)
Sling now - leave until healing
1%
(14/893)
Coaptation splint now - leave until healing
5%
(45/893)
Sarmiento (functional) brace now - leave until healing
13%
(124/893)
Coaptation splint now - in 1-2 weeks transition to Sarmiento brace and leave until healing
28%
(258/893)
Outside my area of expertise - best if I don't vote
2%
(23/893)
How would you manage this injury?
Nonoperative
25%
(236/939)
Operative
73%
(692/939)
Outside my area of expertise - best if I do not vote
1%
(11/939)
If you choose Operative management, how would you manage the injury?
I would not choose Operative management
5%
(49/925)
Open reduction and internal fixation (ORIF) Alone (includes plates, screws, wires and minimally invasive plates)
84%
(777/925)
Intramedullary nail (IMN) Alone
5%
(55/925)
ORIF + IMN
1%
(18/925)
External fixation (ExFix) Alone (includes monoplane, circular fixation)
0%
(5/925)
Closed reduction percutaneous fixation (CRPP) Alone
0%
(3/925)
Other or different combination of above
0%
(2/925)
Outside my area of expertise - best if I don't vote
1%
(16/925)
If you choose ORIF Alone, what surgical approach would you use?
I would not choose ORIF
3%
(33/906)
Posterior
65%
(592/906)
Anterolateral
16%
(153/906)
Direct Lateral
9%
(88/906)
Aggregate anterior
0%
(3/906)
Outside my area of expertise - best if I don't vote
4%
(37/906)
If you choose ORIF Alone with a Posterior Approach, how would you address the triceps?
I would not choose ORIF Alone with a Posterior Approach
4%
(41/880)
Triceps split
45%
(397/880)
Triceps reflecting
12%
(110/880)
Triceps sparing (paratricipital windows medial/lateral)
33%
(296/880)
Other
0%
(4/880)
Outside my area of expertise - best if I don't vote
3%
(32/880)
If you choose ORIF Alone with a Posterior Approach, what nerves would you identify and secure during the procedure?
I would not choose ORIF Alone with a Posterior Approach
2%
(21/868)
None
0%
(6/868)
Ulnar nerve only
5%
(49/868)
Radial nerve only
49%
(433/868)
Radial and ulnar nerve
39%
(344/868)
Outside my area of expertise - best if I don't vote
1%
(15/868)
If you choose ORIF Alone with a Posterior Approach, what fixation technique would you use?
I would not choose ORIF Alone with a Posterior Approach
2%
(25/843)
Lag screw(s) only
0%
(4/843)
Lag screw(s) + neutralization plate
68%
(576/843)
Bridge plating
7%
(66/843)
Compression plating
16%
(139/843)
Other
0%
(4/843)
Outside my area of expertise - best if I don't vote
3%
(29/843)
If you choose ORIF Alone with a Posterior Approach with plate fixation, which plate configuration would you use?
I would not choose ORIF Alone with a Posterior Approach
3%
(26/832)
Single plate - posterior
59%
(499/832)
Single plate - medial
1%
(13/832)
Single plate - lateral
16%
(141/832)
Single plate - anterior
0%
(4/832)
Dual plating - orthogonal (90-90)
9%
(83/832)
Dual plating - parallel
5%
(42/832)
Outside my area of expertise - best if I don't vote
2%
(24/832)
If you choose ORIF and obtained the construct below, would you immobilize the patient postoperatively?
I would not choose ORIF
2%
(18/778)
No - soft dressings only
44%
(348/778)
Yes - splint (e.g. posterior long-arm)
32%
(249/778)
Yes - brace (e.g. functional brace)
19%
(151/778)
Outside my area of expertise - best if I do not vote
1%
(12/778)
If you choose ORIF and obtained the construct below, what weight bearing status would you assign the patient postoperatively?
I would not choose ORIF
2%
(19/766)
Non-weight bearing (NWB)
59%
(453/766)
Partial-weight bearing (< 5 lbs, PWB)
27%
(210/766)
Weight-bearing as tolerated (WBAT)
10%
(78/766)
Outside my area of expertise - best if I don't vote
0%
(6/766)
PROCEDURE #1
DOP: 6/21/2022
Open Reduction Internal Fixation Right Humerus with Posterior approach (CPT 24515)
Intra-procedure P1
OUTCOMES
10 days
Post-procedure P1
24 days
Post-procedure P1