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Pectoralis Major Rupture
Posted: Dec 16 2019 #(C101343)
A

Acute Pectoralis Major Rupture in 40M

HPI

Orthopedic surgeon was weight lifting and bench pressing. When he was lowering the bar down to his chest when he felt a pop and loss of strength in his left arm. Thankfully he had a great spotter.

PMH

None

PE

Neuro-vascular intact. Ecchymosis over the anterior biceps. Anterior pain, palpable defect, and deformity of the anterior axillary fold.

Poll
1 of 12
1. In addition to Xrays, what additional imaging studies would you obtain to determine treatment?
None - Xrays are enough
3%
54/1431
Ultrasound
7%
112/1431
CT Scan
0%
11/1431
MRI
84%
1204/1431
CT Scan and MRI
2%
38/1431
CT and Ultrasound
0%
12/1431
2. If you obtained an MRI, would you get dedicated sequences?
No - I would just order a standard shoulder MRI
30%
406/1352
Yes - Dedicated sequences, but I DON'T need to specify because radiologist and tech will know.
14%
195/1352
Yes - Dedicated sequences and I NEED to specify to obtain it correctly
52%
710/1352
I would not get an MRI in this patient
3%
41/1352
3. How would you treat this patient considering the MRI shows a tendon avulsion from the bone?
Nonoperative (Sling with eventual PT)
9%
125/1358
Operative
90%
1233/1358
4. If you choose Operative treatment, what fixation technique would you use on the humerus?
Transosseous suture repair with cortical trough
22%
279/1255
Suture Anchors - biocomposit/PEEK Screw
31%
401/1255
Suture anchors - all-suture (e.g., JuggerKnot)
17%
223/1255
Cortical Button Fixation
26%
333/1255
I would NOT perform operative treatment
1%
19/1255
5. If you choose Operative treatment in this acute rupture, would you augment your repair with a tendon graft?
No - primary repair only
84%
1007/1186
Yes - I would augment with Tendon ALLOgraft (Achilles etc
7%
87/1186
Yes - I would augment with Dermal ALLOgraft (Achilles etc)
0%
11/1186
Yes - I would augment with tendon AUTOgraft
5%
65/1186
I would NOT perform operative treatment
1%
16/1186
6. If you choose Operative treatment, would you augment it with biologics
No - I would not use biologics
84%
970/1144
Yes - PRP
9%
107/1144
Yes - BMAC
1%
15/1144
Yes - Amnion
0%
11/1144
Yes - PRP and BMAC
2%
29/1144
I would NOT perform operative treatment
1%
12/1144
7. If you choose Operative fixation, how long would you keep the patient in the sling.
2 weeks
14%
165/1165
3 weeks
13%
153/1165
4 weeks
31%
365/1165
5 weeks
1%
13/1165
6 weeks
39%
464/1165
I would NOT perform operative treatment
0%
5/1165
8. If you choose Operative treatment, when would you allow return to sport and athletics that require contact and forceful abduction?
3 months
9%
112/1130
4 months
7%
83/1130
5 months
2%
24/1130
6 months
78%
890/1130
Never
1%
17/1130
I would NOT perform operative treatment
0%
4/1130
9. How would you classify this with the Modified Tietjen (Anatomic) Classification System?
I would not classify it with the Tietjen System - it does not help guide my treatment
63%
568/895
A
3%
29/895
B
5%
49/895
C
11%
101/895
D
9%
89/895
E
3%
27/895
F
3%
32/895
10. If you choose Nonoperative treatment, would you inject any biologics?
No
42%
411/973
Yes - PRP
7%
74/973
Yes - BMAC
0%
4/973
Yes - Amnion
0%
4/973
Yes - Both PRP and BMAC
2%
28/973
I would NOT choose Nonoperative Treatment
46%
452/973
11. If you choose Nonoperative treatment, how long would you keep the patient in the sling.
2 weeks
9%
87/940
3 weeks
3%
31/940
4 weeks
7%
73/940
5 weeks
0%
6/940
6 weeks
20%
191/940
I would NOT choose Nonoperative Treatment
58%
552/940
12. If you choose Nonoperative treatment, when would you allow return to sport and athletics that require contact and forceful abduction?
3 months
8%
75/915
4 months
1%
14/915
5 months
0%
1/915
6 months
22%
203/915
Never
3%
33/915
I would NOT choose Nonoperative Treatment
64%
589/915
PROCEDURE #1

Open Pectoralis Major Repair with unicortical buttons and use of PRP and BMAC.

POLL#
Surgeon's Choices
1
In addition to Xrays, what additional imaging studies would you obtain to determine treatment?
MRI
2
If you obtained an MRI, would you get dedicated sequences?
Yes - Dedicated sequences and I NEED to specify to obtain it correctly
3
How would you treat this patient considering the MRI shows a tendon avulsion from the bone?
Operative
4
If you choose Operative treatment, what fixation technique would you use on the humerus?
Cortical Button Fixation
5
If you choose Operative treatment in this acute rupture, would you augment your repair with a tendon graft?
No - primary repair only
6
If you choose Operative treatment, would you augment it with biologics
Yes - PRP and BMAC
7
If you choose Operative fixation, how long would you keep the patient in the sling.
6 weeks
8
If you choose Operative treatment, when would you allow return to sport and athletics that require contact and forceful abduction?
6 months
9
How would you classify this with the Modified Tietjen (Anatomic) Classification System?
I would not classify it with the Tietjen System - it does not help guide my treatment
10
If you choose Nonoperative treatment, would you inject any biologics?
Yes - Both PRP and BMAC
11
If you choose Nonoperative treatment, how long would you keep the patient in the sling.
6 weeks
12
If you choose Nonoperative treatment, when would you allow return to sport and athletics that require contact and forceful abduction?
6 months
Intra-procedure P1
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OUTCOMES
Post-procedure P1
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