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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%
553/933
Yes - Additional radiographs (aXR) Alone (includes xrays in brace)
20%
193/933
Yes - CT scan (CT) Alone (includes 2D +/- 3D recons)
14%
131/933
Yes - MRI Alone
0%
9/933
Yes - aXR + CT
1%
18/933
Yes - aXR + MRI
0%
2/933
Yes - CT + MRI
0%
3/933
Yes - aXR + CT + MRI
0%
1/933
Other
0%
2/933
Outside my area of expertise - best if I don't vote
2%
21/933
2. How would describe this fracture pattern?
Spiral
78%
789/999
Short oblique
8%
80/999
Long oblique
11%
110/999
Other
0%
7/999
Outside my area of expertise - best if I do not vote
1%
13/999
3. How would you manage this injury?
Nonoperative
25%
250/986
Operative
73%
725/986
Outside my area of expertise - best if I do not vote
1%
11/986
4. If you choose Nonoperative management as definitive treatment, what technique would you choose?
I would not choose Nonoperative management
47%
452/942
Sling now - leave until healing
1%
14/942
Coaptation splint now - leave until healing
4%
46/942
Sarmiento (functional) brace now - leave until healing
14%
132/942
Coaptation splint now - in 1-2 weeks transition to Sarmiento brace and leave until healing
29%
274/942
Outside my area of expertise - best if I don't vote
2%
24/942
5. If you choose Operative management, how would you manage the injury?
I would not choose Operative management
5%
56/972
Open reduction and internal fixation (ORIF) Alone (includes plates, screws, wires and minimally invasive plates)
83%
814/972
Intramedullary nail (IMN) Alone
5%
57/972
ORIF + IMN
1%
19/972
External fixation (ExFix) Alone (includes monoplane, circular fixation)
0%
5/972
Closed reduction percutaneous fixation (CRPP) Alone
0%
3/972
Other or different combination of above
0%
2/972
Outside my area of expertise - best if I don't vote
1%
16/972
6. If you choose ORIF Alone, what surgical approach would you use?
I would not choose ORIF
3%
36/953
Posterior
65%
626/953
Anterolateral
16%
160/953
Direct Lateral
9%
91/953
Aggregate anterior
0%
3/953
Outside my area of expertise - best if I don't vote
3%
37/953
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%
42/925
Triceps split
44%
415/925
Triceps reflecting
12%
120/925
Triceps sparing (paratricipital windows medial/lateral)
33%
311/925
Other
0%
4/925
Outside my area of expertise - best if I don't vote
3%
33/925
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%
22/913
None
0%
6/913
Ulnar nerve only
5%
50/913
Radial nerve only
50%
462/913
Radial and ulnar nerve
39%
358/913
Outside my area of expertise - best if I don't vote
1%
15/913
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%
26/887
Lag screw(s) only
0%
5/887
Lag screw(s) + neutralization plate
68%
604/887
Bridge plating
8%
71/887
Compression plating
16%
146/887
Other
0%
4/887
Outside my area of expertise - best if I don't vote
3%
31/887
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%
27/875
Single plate - posterior
60%
525/875
Single plate - medial
1%
14/875
Single plate - lateral
17%
149/875
Single plate - anterior
0%
4/875
Dual plating - orthogonal (90-90)
9%
87/875
Dual plating - parallel
4%
43/875
Outside my area of expertise - best if I don't vote
2%
26/875
11. If you choose ORIF and obtained the construct below, would you immobilize the patient postoperatively?
I would not choose ORIF
2%
19/819
No - soft dressings only
45%
372/819
Yes - splint (e.g. posterior long-arm)
31%
257/819
Yes - brace (e.g. functional brace)
19%
158/819
Outside my area of expertise - best if I do not vote
1%
13/819
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%
20/807
Non-weight bearing (NWB)
58%
472/807
Partial-weight bearing (< 5 lbs, PWB)
28%
226/807
Weight-bearing as tolerated (WBAT)
10%
83/807
Outside my area of expertise - best if I don't vote
0%
6/807
PROCEDURE #1 DOP: 6/21/2022

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

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