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Radius and Ulnar Shaft Fractures
Posted: Sep 27 2020 #(C101587)
A

Proximal Both Bone Forearm Fracture in 28M

HPI

28-year-old male involved in a high-energy mountain bike jump with direct impact onto the arm. Denies LOC or head injury. This is an isolated injury. Denies numbness in the hand.

PMH

None, otherwise active and healthy

PE

The injury is closed, with minor superficial overlying abrasions. There is moderate swelling and deformity about the forearm. The extremity is otherwise neurovascularly intact distally with no motor or sensory deficits. The hand is warm and well-perfused with a 2+ symmetric radial pulse.

Poll
1 of 9
1. In addition to the plain film radiographs, would you obtain any additional imaging to guide management?
No - current xrays sufficient
85%
1585/1856
Yes - additional radiographs
5%
106/1856
Yes - CT scan
5%
99/1856
Yes - MRI scan
0%
9/1856
Yes - CT and radiographs
0%
12/1856
Yes - MRI and radiographs
0%
2/1856
Yes - MRI and CT
0%
6/1856
Yes - MRI, CT, and radiographs
0%
4/1856
Outside of my area of expertise - best if I don't vote
1%
33/1856
2. Would you use a classification system to guide management?
No - a classification system would not help me
63%
1131/1778
Yes - AO/OTA classification
32%
569/1778
Yes - Other
1%
22/1778
Yes - descriptiveOutside my area of expertise - best if I don't vote
3%
56/1778
3. How would you manage this injury?
Operative
98%
1779/1800
Nonoperative
0%
12/1800
Outside my area of expertise - best if I don't vote
0%
9/1800
4. If you choose Operative management, how would you plan to definitively manage this injury?
I would not choose operative management
0%
1/1801
External fixation
0%
7/1801
Percutaneous pinning (include post-op casting)
0%
17/1801
Flexible IM rods
4%
77/1801
Open reduction internal fixation (ORIF)
93%
1687/1801
Outside my area of expertise - best if I don't vote
0%
12/1801
5. If you choose ORIF, which bone would you fix first?
I would not choose ORIF
0%
4/1811
Ulna
48%
884/1811
Radius
49%
890/1811
Outside my area of expertise - best if I don't vote
1%
33/1811
6. If you choose ORIF, what approach would you use for the radius?
I would not choose ORIF
0%
6/1715
Volar Henry
59%
1022/1715
Dorsal Thompson
29%
502/1715
Lateral elbow approach (Kaplan)
6%
116/1715
Outside my area of expertise - best if I don't vote
4%
69/1715
7. If you choose ORIF of the radius, what implant would you use?
I would not choose ORIF of the radius
0%
11/1751
2.7mm plate
6%
113/1751
3.5mm LC/DCP plate
78%
1375/1751
3.5mm recon plate
4%
86/1751
1/3rd tubular plate
3%
61/1751
Other
1%
24/1751
Outside my area of expertise - best if I don't voteher
4%
81/1751
8. If you choose Operative management and attain the construct shown below, how would you immobilize the patient postoperatively?
I would not choose Operative management
0%
4/1600
Soft dressing only
39%
625/1600
Short arm plaster reinforced volar splint
13%
221/1600
Long arm plaster reinforced volar splint
45%
729/1600
Outside my area of expertise - best if I dont vote
1%
21/1600
9. If you choose Operative management and attain the construct shown below, when would you initiate range of motion post-operatively?
I would not choose Operative management
0%
1/1650
Immediately
28%
471/1650
1 week
11%
183/1650
2 weeks
33%
556/1650
4 weeks
15%
255/1650
6 weeks
9%
149/1650
>6 weeks
0%
12/1650
Outside my area of expertise - best if I don't vote
1%
23/1650
PROCEDURE #1 DOP: 9/22/2020

Open reduction and internal fixation of radial and ulnar shaft fractures

Intra-procedure P1
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OUTCOMES
5 weeks after
Post-procedure P1
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