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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%
1937/2350
Yes - additional radiographic views (XR)
10%
253/2350
Yes - CT scan of the shoulder (CT)
2%
55/2350
Yes - MRI scan of the shoulder (MRI)
0%
16/2350
Yes - XR + CT
1%
27/2350
Yes - XR + MRI
0%
3/2350
Yes - CT + MRI
0%
3/2350
Yes - XR + CT + MRI
0%
5/2350
Outside my area of expertise, best if I do not answer
2%
51/2350
2. Would you use a classification system to guide management?
No - a classification system would not help me
62%
1385/2220
Yes - Neer Classification
16%
367/2220
Yes - AO classification
14%
312/2220
Yes - Other
2%
47/2220
Outside my area of expertise - best if I don't vote
4%
109/2220
3. How would you manage this injury?
Nonoperative
53%
1238/2325
Operative
45%
1059/2325
Outside my area of expertise - best if I don't vote
1%
28/2325
4. If you choose Nonoperative management, what immobilization treatment would you choose?
I would not choose Nonoperative management
16%
369/2180
No immobilization
1%
42/2180
Sling
59%
1297/2180
Figure-of-eight brace
19%
424/2180
Other
0%
14/2180
Outside my area of expertise - best if I don't vote
1%
34/2180
5. If you choose Nonoperative management, what activity would you prescribe initially?
I would not choose Nonoperative management
16%
347/2101
Non-weight-bearing (NWB)
59%
1241/2101
Partial-weight bearing (< 5-10 lbs, PWB)
9%
198/2101
Weight bearing as tolerated (WBAT)
12%
266/2101
Outside my area of expertise - best if I don't vote
2%
49/2101
6. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
24%
528/2121
Closed reduction with intramedullary implant
3%
68/2121
Open reduction with intramedullary implant
1%
41/2121
Open reduction internal fixation with plate(s) and screws
67%
1438/2121
Outside my area of expertise - best if I don't vote
2%
46/2121
7. If you choose Operative management, how would you position the patient?
I would not choose Operative management
14%
298/1989
Beach chair with an arm holder
61%
1232/1989
Radiolucent flat top with a plexi glass attachment
7%
142/1989
Regular bed with hand table or radiolucent extension
8%
179/1989
Other
2%
48/1989
Outside my area of expertise - best if I don't vote
4%
90/1989
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%
193/1922
Superior plating only
71%
1383/1922
Anterior plating only
9%
180/1922
Dual (90-90, anterior + superior) plating
4%
84/1922
Outside my area of expertise - best if I don't vote
4%
82/1922
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%
166/1858
Bridge only (includes locking)
20%
377/1858
Compression only
18%
338/1858
Lag-neutralization (place lag screw first then plate)
47%
887/1858
Outside my area of expertise - best if I don't vote
4%
90/1858
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%
145/1790
2 cortices (1 screw) medial to fx
3%
54/1790
4 cortices (2 screws) medial to fx
11%
205/1790
6 cortices (3 screws) medial to fx
70%
1255/1790
8 cortices (4 screws) medial to fx
3%
59/1790
Outside my area of expertise - best if I don't vote
4%
72/1790
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%
113/1813
Non-weight bearing (NWB)
40%
740/1813
Partial weight bearing (PWB) less than 5-10 lbs
37%
684/1813
Weight bearing as tolerated (WBAT)
12%
234/1813
Outside my area of expertise - best if I don't vote
2%
42/1813
PROCEDURE #1

ORIF Left Clavicle

Intra-procedure P1
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