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An 19-year-old male presents to the emergency room following an motor vehicle accident as an unrestrained driver. Examination reveals unilateral jugular vein engorgement. Chest and special view radiographs are seen in Figures A and B respectively. Following CT scan of the chest, the next step in management is
Nonsurgical management and follow-up CT scan in 6 weeks
Closed reduction in the emergency room under sedation
Closed reduction in the operating room under general anesthesia with thoracic surgery on standby, followed by immobilization for 4 weeks
Closed reduction in the operating room under general anesthesia with thoracic surgery on standby, followed by compression plating
Open reduction in the operating room under general anesthesia, followed by transarticular pinning with K-wires
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Which of the following is true regarding anterior sternoclavicular joint dislocations?
Reduction may result in tracheal injury
They are usually stable following closed reduction
They require fusion to hold the reduction
They are rarely symptomatic when left unreduced
They should be treated acutely with medial clavicle excision
A 33-year-old secretary presents three months after a motor vehicle collision with a mild asymmetry to her sternal area and difficulty swallowing. She denies any complaints of respiratory distress or upper extremity paresthesias. Her upper extremity neurovascular exam shows no deficits. A 3-D computed tomography image is shown in Figure A. What is the most appropriate treatment for this patient?
Nonoperative treatment with a sling and unrestricted activity in 3 months
Open reduction in the operating room with thoracic surgery back-up
Closed reduction in the office with local anesthetic
Closed reduction in the operating room with thoracic surgery back-up
Nonoperative treatment with immediate unrestricted active range of motion of the shoulder
A 33-year-old female is diagnosed with spontaneous atraumatic subluxation of the sternoclavicular joint. She notes mild, intermittent pain and a small amount of prominence to that area. She is noted to have 6 points out of a possible 9 points on the Beighton-Horan scale. What is the most appropriate treatment at this time?
Figure of eight brace for 6 weeks followed by progressive physical therapy
Resection arthroplasty of the sternoclavicular joint
Sternoclavicular and costoclavicular ligament reconstruction
A 16-year-old male fell from a roof onto his right shoulder and presents with decreased pulses in his right upper extremity. Imaging reveals a posterior sternoclavicular dislocation. What is the best treatment at this time?
Nonoperative treatment with a sling and swathe for six weeks
Nonoperative treatment with immediate active range of motion of the shoulder
Closed reduction in the emergency room
Open reduction and pinning of his medial clavicular physeal injury
Reduction in the operating room with thoracic surgery back-up