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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.

Poll
1 of 12
1. 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%
549/928
Yes - Additional radiographs (aXR) Alone (includes xrays in brace)
20%
192/928
Yes - CT scan (CT) Alone (includes 2D +/- 3D recons)
14%
131/928
Yes - MRI Alone
0%
9/928
Yes - aXR + CT
1%
18/928
Yes - aXR + MRI
0%
2/928
Yes - CT + MRI
0%
3/928
Yes - aXR + CT + MRI
0%
1/928
Other
0%
2/928
Outside my area of expertise - best if I don't vote
2%
21/928
2. How would describe this fracture pattern?
Spiral
78%
785/994
Short oblique
7%
79/994
Long oblique
11%
110/994
Other
0%
7/994
Outside my area of expertise - best if I do not vote
1%
13/994
3. If you choose Nonoperative management as definitive treatment, what technique would you choose?
I would not choose Nonoperative management
48%
451/937
Sling now - leave until healing
1%
14/937
Coaptation splint now - leave until healing
4%
46/937
Sarmiento (functional) brace now - leave until healing
13%
131/937
Coaptation splint now - in 1-2 weeks transition to Sarmiento brace and leave until healing
28%
271/937
Outside my area of expertise - best if I don't vote
2%
24/937
4. How would you manage this injury?
Nonoperative
25%
247/981
Operative
73%
723/981
Outside my area of expertise - best if I do not vote
1%
11/981
5. If you choose Operative management, how would you manage the injury?
I would not choose Operative management
5%
55/967
Open reduction and internal fixation (ORIF) Alone (includes plates, screws, wires and minimally invasive plates)
83%
810/967
Intramedullary nail (IMN) Alone
5%
57/967
ORIF + IMN
1%
19/967
External fixation (ExFix) Alone (includes monoplane, circular fixation)
0%
5/967
Closed reduction percutaneous fixation (CRPP) Alone
0%
3/967
Other or different combination of above
0%
2/967
Outside my area of expertise - best if I don't vote
1%
16/967
6. If you choose ORIF Alone, what surgical approach would you use?
I would not choose ORIF
3%
36/949
Posterior
65%
623/949
Anterolateral
16%
159/949
Direct Lateral
9%
91/949
Aggregate anterior
0%
3/949
Outside my area of expertise - best if I don't vote
3%
37/949
7. 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%
42/921
Triceps split
44%
414/921
Triceps reflecting
12%
117/921
Triceps sparing (paratricipital windows medial/lateral)
33%
311/921
Other
0%
4/921
Outside my area of expertise - best if I don't vote
3%
33/921
8. 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%
22/909
None
0%
6/909
Ulnar nerve only
5%
50/909
Radial nerve only
50%
458/909
Radial and ulnar nerve
39%
358/909
Outside my area of expertise - best if I don't vote
1%
15/909
9. 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%
26/884
Lag screw(s) only
0%
5/884
Lag screw(s) + neutralization plate
67%
601/884
Bridge plating
8%
71/884
Compression plating
16%
146/884
Other
0%
4/884
Outside my area of expertise - best if I don't vote
3%
31/884
10. 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%
27/872
Single plate - posterior
59%
523/872
Single plate - medial
1%
13/872
Single plate - lateral
17%
149/872
Single plate - anterior
0%
4/872
Dual plating - orthogonal (90-90)
9%
87/872
Dual plating - parallel
4%
43/872
Outside my area of expertise - best if I don't vote
2%
26/872
11. If you choose ORIF and obtained the construct below, would you immobilize the patient postoperatively?
I would not choose ORIF
2%
19/816
No - soft dressings only
45%
370/816
Yes - splint (e.g. posterior long-arm)
31%
257/816
Yes - brace (e.g. functional brace)
19%
157/816
Outside my area of expertise - best if I do not vote
1%
13/816
12. 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%
20/804
Non-weight bearing (NWB)
58%
469/804
Partial-weight bearing (< 5 lbs, PWB)
28%
226/804
Weight-bearing as tolerated (WBAT)
10%
83/804
Outside my area of expertise - best if I don't vote
0%
6/804
PROCEDURE #1 DOP: 6/21/2022

Open Reduction Internal Fixation Right Humerus with Posterior approach (CPT 24515)

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