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A 35-year-old right hand dominant man falls from a ladder and sustains the injury seen in Figure A. When discussing the risks and benefits of operative versus nonoperative treatment for his fracture, which of the following is true?
No difference in shoulder function
Higher risk of nonunion with operative management
Higher risk of symptomatic malunion or nonunion with nonoperative management
Earlier return to sport with nonoperative management
No difference in union rates
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A 45-year-old male falls onto his left shoulder while biking and an injury radiograph is shown in Figure A. He elects for nonoperative treatment. What is the most likely clinical outcome at one year after injury?
Symmetric cosmesis of shoulders
Decreased shoulder motion
Decreased shoulder strength and endurance
A 32-year-old female sustains an isolated midshaft clavicle fracture, as shown in Figure A. Her clinical exam does not reveal skin tenting or neurovascular injury, but shortening is measured at 2.6 cm. Which of the following treatment methods has been shown to have the lowest rate of nonunion and symptomatic malunion?
Open reduction and internal fixation with plating
Open reduction and percutaneous pinning
Closed reduction and percutaneous pinning
Closed reduction and external fixation
Nonoperative treatment with a sling and early range of motion
A 25-year-old patient is involved in a motor vehicle accident. An isolated orthopaedic injury is sustained to the upper extremity with no compromise of skin integrity or neurovascular function. A radiograph of the injury is shown in Figure A. The patient is interested in pursuing surgical intervention. What is a reported outcome of surgery when compared to nonoperative management at 1 year postoperatively?
Increased rates of symptomatic nonunion
Similar rates of symptomatic nonunion
No differences in cosmetic results
Increased functional outcome scores
Improved range of motion of the shoulder
A 22-year-old left hand dominant laborer sustains the injury shown in Figures A and B as the result of a fall from a ladder. Which of the following has been shown to be true regarding operative versus nonoperative treatment of this injury?
Decreased chance of nonunion with nonoperative treatment
Improved Constant and DASH scores with operative treatment at all time points
Increased symptomatic malunion rate with operative treatment
No change in shoulder abduction strength
Increased time to union with operative treatment
Which of the following factors is associated with the highest rate of nonunion of a midshaft clavicle fracture?
simple fracture pattern
A 31-year-old male sustains the injury shown in Figure A. As compared to treatment with a simple sling, what is the primary advantage of treatment with a figure-of-eight brace?
Decreased sleep disturbance
Decreased personal care and hygiene impairment
Decreased rates of malunion
Improved long-term clinical outcomes
No advantage, equivalent result between a simple sling and figure-of-eight brace
A 22-year-old male sustains a right shoulder injury after being thrown from his motorcycle. After nine months of conservative treatment, he continues to complain of pain. A current radiograph is shown in Figure A. What is the most appropriate treatment?
Addition of a bone stimulator
Figure of eight brace
Open reduction and intramedullary nailing
Open reduction and compression plating
A 20-year-old woman is involved in a high-speed motor vehicle collision and sustains bilateral tibial plateau fractures as well as the clavicle fracture shown in Figure A. What is the most appropriate management of the clavicular injury?
Closed reduction and figure of 8 splinting
Open reduction and plate fixation
Simple sling to involved side
Sling with abduction pillow to involved side
Which of the following factors increase the risk of nonunion in midshaft clavicle fractures when treated nonoperatively?
Displacement and comminution
Age less than 40 years old
Immediate motion exercises
Titanium elastic nailing vs anatomical plate - what are you thoughts?
16 year-old female basketball player requesting surgery for her clavicle fr...
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Session III Author: L. Pearce McCarty, III, MD Duration: 11:57
HPI - RTA victim
How would you choose to manage this fracture?
HPI - A 30 year old male patient presents with right shoulder pain following an MVA. At the behest of his mother, patient wants surgery. He specifically requests an IM nail. After reviewing his radiographs, I recommended non-operative treatment.
The patient traveled to another surgeon for a second opinion, which resulted in IM fixation of his clavicle fracture. 4 weeks s/p IM nail, patient presents to the ER with complaints of pain, fever, and chills.
Physical exam yields erythematous incision, purulent drainage and wound dehiscence. Skin is warm and tender to palpation near clavicle.
How would you address the infection in this patient?
HPI - A 30 year old male patient presents with 6 months of right clavicle pain following ORIF for a clavicle nonunion after fracturing his clavicle in a motor vehicle accident.
He was initially treated non-operatively, but went on to develop a nonunion at the fracture site. He then underwent ORIF with graft and did well at first, but is now extremely painful.
XRays and CT are shown.
After ruling out infection, would you offer revision surgery?