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Clavicle Fractures - Midshaft
Posted: Mar 10 2021 #(C101729)
A

Midshaft Clavicle Fracture in 31M

HPI

A 31-year-old male presents after a motor vehicle collision. He complains of isolated left shoulder pain. He has no other injuries and denies any loss of consciousness. Denies any numbness or tingling to the left upper extremity.

PMH

0.5 pack per day smoker

PE

A focused physical examination of the left upper extremity reveals an obvious deformity over the clavicle without open wounds. Skin is tented but intact and blanchable. Pain with movement of the shoulder but no other pain in the arm and forearm. Sensation and motor are intact distally and 2+ pulses are present

Poll
1 of 11
1. In addition to plain film clavicle radiographs, would you obtain any additional imaging to guide treatment?
No - current radiographs are sufficient
82%
1937/2349
Yes - additional radiographic views (XR)
10%
253/2349
Yes - CT scan of the shoulder (CT)
2%
54/2349
Yes - MRI scan of the shoulder (MRI)
0%
16/2349
Yes - XR + CT
1%
27/2349
Yes - XR + MRI
0%
3/2349
Yes - CT + MRI
0%
3/2349
Yes - XR + CT + MRI
0%
5/2349
Outside my area of expertise, best if I do not answer
2%
51/2349
2. Would you use a classification system to guide management?
No - a classification system would not help me
62%
1385/2219
Yes - Neer Classification
16%
366/2219
Yes - AO classification
14%
312/2219
Yes - Other
2%
47/2219
Outside my area of expertise - best if I don't vote
4%
109/2219
3. How would you manage this injury?
Nonoperative
53%
1238/2324
Operative
45%
1058/2324
Outside my area of expertise - best if I don't vote
1%
28/2324
4. If you choose Nonoperative management, what immobilization treatment would you choose?
I would not choose Nonoperative management
16%
369/2179
No immobilization
1%
42/2179
Sling
59%
1296/2179
Figure-of-eight brace
19%
424/2179
Other
0%
14/2179
Outside my area of expertise - best if I don't vote
1%
34/2179
5. If you choose Nonoperative management, what activity would you prescribe initially?
I would not choose Nonoperative management
16%
347/2100
Non-weight-bearing (NWB)
59%
1240/2100
Partial-weight bearing (< 5-10 lbs, PWB)
9%
198/2100
Weight bearing as tolerated (WBAT)
12%
266/2100
Outside my area of expertise - best if I don't vote
2%
49/2100
6. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
24%
528/2120
Closed reduction with intramedullary implant
3%
68/2120
Open reduction with intramedullary implant
1%
41/2120
Open reduction internal fixation with plate(s) and screws
67%
1437/2120
Outside my area of expertise - best if I don't vote
2%
46/2120
7. If you choose Operative management, how would you position the patient?
I would not choose Operative management
14%
298/1988
Beach chair with an arm holder
61%
1232/1988
Radiolucent flat top with a plexi glass attachment
7%
141/1988
Regular bed with hand table or radiolucent extension
9%
179/1988
Other
2%
48/1988
Outside my area of expertise - best if I don't vote
4%
90/1988
8. If you choose Open reduction and internal fixation (ORIF) with plate(s) and screws, what construct would you select?
I would not choose ORIF with plate(s) and screws
10%
193/1921
Superior plating only
71%
1383/1921
Anterior plating only
9%
179/1921
Dual (90-90, anterior + superior) plating
4%
84/1921
Outside my area of expertise - best if I don't vote
4%
82/1921
9. If you choose Open reduction and internal fixation (ORIF) with plate(s) and screws, what plate function would you plan on?
I would not choose ORIF with plate(s) and screws
8%
166/1857
Bridge only (includes locking)
20%
377/1857
Compression only
18%
338/1857
Lag-neutralization (place lag screw first then plate)
47%
886/1857
Outside my area of expertise - best if I don't vote
4%
90/1857
10. If you choose ORIF with plate(s), screws, and Lag-neutralization, how many cortices of purchase would you obtain Medial to fracture?
I would not choose ORIF with plate(s) and screws
8%
145/1789
2 cortices (1 screw) medial to fx
3%
54/1789
4 cortices (2 screws) medial to fx
11%
205/1789
6 cortices (3 screws) medial to fx
70%
1254/1789
8 cortices (4 screws) medial to fx
3%
59/1789
Outside my area of expertise - best if I don't vote
4%
72/1789
11. If you choose Operative management and attained the construct shown, how would you manage post-operative weight-bearing?
I would not choose construct below
6%
113/1812
Non-weight bearing (NWB)
40%
740/1812
Partial weight bearing (PWB) less than 5-10 lbs
37%
683/1812
Weight bearing as tolerated (WBAT)
12%
234/1812
Outside my area of expertise - best if I don't vote
2%
42/1812
PROCEDURE #1

ORIF Left Clavicle

Intra-procedure P1
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