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Review Question - QID 8157

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QID 8157 (Type "8157" in App Search)
Figure 23 is the radiograph of a 22-year-old woman who was involved in a motor vehicle collision. She reports isolated pain in her left shoulder. She is hemodynamically stable, respiring comfortably, and neurovascularly intact. Based on these findings, which of the following statements regarding treatment is most appropriate?
  • A

Union rates are in excess of 95% if treated nonsurgically.

2%

34/1414

A figure-of-8 brace is superior to a sling for nonsurgical management.

0%

6/1414

Open reduction and internal fixation increases the likelihood of a nonunion.

1%

8/1414

Open reduction and internal fixation results in improved functional outcomes.

76%

1069/1414

Open reduction and internal fixation and nonsurgical management have equivalent outcomes at 1 year.

20%

284/1414

  • A

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The patient has sustained an isolated, closed, transverse fracture of the middle third of the clavicle with greater than 100% displacement and greater than 2 cm of shortening. Whereas the traditional treatment of clavicle fractures has been overwhelmingly conservative, recent reports suggest that surgical fixation should be considered for certain injury patterns. The union rates of displaced clavicle fractures are more recently noted to be approximately 85%, which is lower than the traditional literature. In a prospective randomized trial of clavicle fractures with greater than 100% displacement, union rates were higher and functional outcomes were better at all time points up to 1 year after injury in the surgical group when compared with nonsurgical management.

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