Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Monteggia Fractures
Posted: Sep 22 2020 #(C101583)
A

Open Monteggia Fracture from GSW in 23F

HPI

A 23-year-old female, right-hand-dominant, presents to the ED after sustaining a GSW to the left elbow. She reports her husband was cleaning a gun when it accidentally discharged. She denies any numbness/tingling in the hand.

PMH

Noncontributory

PE

A focused physical exam of the left upper extremity reveals a small entry wound on the posterior/medial elbow and a large exit wound on the volar forearm. She is motor intact to the hand as demonstrated by the cardinal hand motions and active flexion/extension of the DIP/PIP/MCP of all fingers. Her sensation is intact distally. Her compartments are soft. Her capillary refill is less than 2 seconds and her radial pulse is palpable.

Poll
1 of 12
1. In addition to the plain film radiographs, would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
11%
71/637
Yes - additional radiographic views (aXR, i.e traction views)
0%
6/637
Yes - CT scan of the elbow (CT)
79%
504/637
Yes - MRI scan of the elbow (MRI)
1%
7/637
Yes - CT + aXR
4%
30/637
Yes - MRI + aXR
0%
0/637
Yes - MRI + CT
1%
9/637
Yes - MRI + CT + aXR
0%
1/637
Outside my area of expertise - best if I don't vote
1%
9/637
2. Would you use a classification system to guide management?
No - a classification system would not help me
49%
291/592
Yes - AO/OTA
18%
108/592
Yes - Bado
21%
125/592
Yes - Jupiter
4%
24/592
Yes - Other
1%
11/592
Outside my area of expertise - best if I don't vote
5%
33/592
3. Would you initiate antibiotics upon presentation, and if so which ones?
No - antibiotics are not indicated
3%
20/627
Yes - 1st generation cephalosporin (Ancef) only
46%
289/627
Yes - 1st generation cephalosporin + aminoglycoside
33%
213/627
Yes - 1st generation cephalosporin + aminoglycoside + penicillin
10%
66/627
Yes - Other combination
4%
26/627
Outside my area of expertise - best if I don't vote
2%
13/627
4. How would you manage this injury?
Nonoperative
1%
8/610
Operative
97%
594/610
Outside my area of expertise - best if I don't vote
1%
8/610
5. If you choose Operative management, would you do a Staged Procedure, or a Single procedure?
I would not choose Operative management
0%
1/576
Staged Procedure - I would perform I&D and temporizing fixation as a first stage, followed by delayed definitive fixation
42%
242/576
Single Procedure - I would perform irrigation and debridement (I&D) and definitive fixation in single setting
54%
316/576
Outside my area of expertise - best if I don't vote
2%
17/576
6. If you choose Staged Operative management, following your I&D, what would be your choice of temporizing fixation?
I would not choose Staged Operative management
31%
176/552
Splint
11%
64/552
External fixation (ExFix)
50%
281/552
Closed reduction and percutaneous pinning (CRPP)
3%
19/552
Outside my area of expertise - best if I don't vote
2%
12/552
7. If you choose Single Procedure Operative management, in addition to an I&D, what would be your choice of definitive fixation?
I would not choose Single Procedure Operative management
10%
59/547
I&D only, no fixation
0%
0/547
External fixation (ExFix) only
1%
10/547
Closed reduction and percutaneous pinning (CRPP)
1%
9/547
Open reduction internal fixation (ORIF)
75%
415/547
ExFix + CRPP
2%
15/547
ExFix + ORIF
4%
26/547
Arthroplasty
0%
3/547
Outside my area of expertise - best if I don't vote
1%
10/547
8. If you choose Single Procedure Operative management with ORIF, assuming the patient presents at 1am and is otherwise stable, when would you take the patient to the operating room?
I would not choose Single Procedure Operative management with ORIF
6%
36/531
Emergently, overnight (within 2-3 hours)
12%
68/531
Urgently, first thing in the morning (within 4-6 hours)
42%
228/531
Semi-urgently, the following day (within 7-12hrs)
26%
141/531
Routinely, within 13-24 hours
7%
39/531
Routinely, within > 24 hours
2%
11/531
Outside my area of expertise - best if I don't vote
1%
8/531
9. If you choose Single Procedure Operative management with ORIF, would you use any regional anesthesia?
I would not choose Single Procedure Operative management with ORIF
5%
26/515
No - I would not use regional anesthesia
44%
230/515
Yes - Interscalene regional block
17%
89/515
Yes - Supraclavicular block
21%
109/515
Yes - Exparel injection (liposomal bupivacaine)
1%
9/515
Yes - other
0%
3/515
Outside my area of expertise - best if I don't vote
9%
49/515
10. If you choose Single Procedure Operative management with ORIF, how would you plan to fix the coronoid fragment?
I would not choose Single Procedure Operative management with ORIF
3%
18/499
I would not plan to fix the coronoid fragment
1%
7/499
Fragment specific plate and screws
20%
101/499
Lag screw(s) only
5%
28/499
Screw(s) through an olecranon plate
21%
105/499
Suture through drill holes
7%
36/499
Lag screw(s) + Screw(s) through an olecranon plate
20%
102/499
Lag screw(s) + Suture
4%
23/499
Fragment specific plate and screw(s) + Suture
10%
51/499
Outside my area of expertise - best if I don't vote
5%
28/499
11. If you choose Single Procedure Operative management with ORIF, and obtained the construct below, when would you allow full range of motion?
I would not choose Single Procedure Operative management with Open Reduction Internal Fixation (ORIF)
3%
16/506
Immediately
14%
71/506
< 2 weeks
25%
129/506
2-4 weeks
33%
172/506
5-6 weeks
18%
93/506
7-8 weeks
2%
13/506
> 8 weeks
0%
2/506
Outside my area of expertise - best if I don't vote
1%
10/506
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
1%
8/480
No - I would not recommend HO prophylaxis
37%
182/480
Yes - Indomethacin Orally
55%
265/480
Yes - Radiation
0%
4/480
Outside of my area of expertise - best I don't answer
4%
21/480
PROCEDURE #1 DOP: 9/20/2020

Left Elbow Irrigation and debridement and Left Olecranon Open Reduction Internal Fixation

Intra-procedure P1
icon
OUTCOMES
6 months after
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options