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Clavicle Fractures - Midshaft
Posted: May 21 2016 #(C2585)
A

Displaced Midshaft Clavicle Fracture in 72F

HPI

o 72 year old right hand dominant presents to clinic with a 1 week history of right shoulder pain o Her symptoms began after a mechanical fall onto her right shoulder o Moderate pain and difficulty with activities of daily living o Very active lifestyle involving gardening and apple picking on her farm

PMH

o Previous right clavicle fracture treated nonoperatively o She had a significant deformity prior to her fall that bothered her No significant PMHx. No Medications. No allergies. Non-smoker.

PE

• Bruising over right clavicle. Shortening of the right shoulder girdle. No evidence of skin tenting • Palpation: Tenderness over right clavicle • ROM: Limited right shoulder ROM due to pain • Neurovasculalry intact

Poll
1 of 8
1. How would you treat this fracture?
Non-operative
37%
788/2089
Operative
62%
1301/2089
2. If you choose nonoperative management, which would you use?
Sling immobilization
74%
1199/1613
Figure-of-eight
25%
414/1613
3. If you choose operative treatment, what techniques would you use?
Superior plate - Precontoured
63%
1126/1783
Superior plate - NOT Precontoured
11%
204/1783
Antero-inferior plate - Precontoured
14%
252/1783
Antero-inferior plate - NOT Precontoured
3%
66/1783
Hook plate
2%
47/1783
Intramedullary flexible nail
4%
88/1783
4. Based on your interpretation of the imaging provided, how much shortening do you think the patient has?
~ 5mm (Minimal shortening)
8%
150/1715
~1 cm
12%
221/1715
~ 1.5cm
12%
215/1715
~ 2 cm
30%
521/1715
> 2.5cm
28%
481/1715
Difficult to determine shortening on these films
7%
127/1715
5. Would you get a CT scan to help evaluate shortening and displacement and dictate treatment?
Yes
13%
245/1770
No
86%
1525/1770
6. If you choose surgery, what is your indication for doing so?
Shortening
12%
218/1734
Displacement
9%
173/1734
Shortening and displacement
58%
1023/1734
I would NOT recommend surgery
18%
320/1734
7. Based on the old CXR and symptoms, did this patient have a malunion ?
Yes
43%
739/1708
No
34%
583/1708
No sure from information provided
22%
386/1708
8. Looking at the postoperative films below, would you consider this an acceptable fracture reduction?
Yes
72%
1204/1653
No
9%
156/1653
Need additional xrays to determine
17%
293/1653
PROCEDURE #1

Clavicle ORIF

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OUTCOMES
Post-procedure P1
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