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4.4 of 42 Ratings
A 50-year-old male sustained a humeral shaft fracture treated operatively 6 months ago. He denies medical problems but smokes 10 cigarettes per day. His current radiograph is shown in Figure A. He continues to have pain in his arm that is affecting his quality of life. On physical examination, there is motion at the fracture site. C-reactive protein and erythrocyte sedimentation rate are within normal limits. Which is the most appropriate definitive treatment for this fracture?
Exchange humeral nailing
Nail removal with open reduction compression plating
Smoking cessation and medical optimization
Nail removal with open reduction and compression plating with bone grafting
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A 58-year-old African-American female who sustained an injury to her upper arm six months ago presents with persistent arm pain. She was initially treated with splinting, with conversion to fracture bracing. She is neurovascularly intact. An injury radiograph and a current radiograph are shown in Figures A and B respectively. What nutritional or metabolic disturbance is the most likely associated with this patient's diagnosis?
Vitamin A deficiency
Low serum testosterone
Low serum thyroxine
Vitamin D deficiency
A 71-year-old man presents after 9 months of functional bracing for a closed right humeral shaft fracture. Current radiographs are shown in Figure A. Infectious workup was negative. Appropriate next steps in evaluation will most likely reveal which of the following?
Figure A is a radiograph of an 80-year-old woman who sustained a closed injury to her left arm 10 months ago. She presents to office today complaining of persistent pain in her arm. What is the most likely metabolic or endocrine abnormality contributing to this patients presentation?
Parathyroid hormone disorder
A 42-year-old man reports persistent arm pain after undergoing intramedullary nailing of a humeral shaft fracture 13 months ago. Physical exam shows near normal shoulder and elbow range-of-motion. Infection work-up is normal. A radiograph is shown in Figure A. What is the next most appropriate step in treatment?
Manipulation under anesthesia
Nail removal and plate fixation
Nail removal and placement of Sarmiento brace
A 33-year-old male presents 9 months after a fall from 15 feet. He complains of continued pain over his left arm and you elicit pain and gross movement with palpation of his humerus. Infectious workup is negative and a radiograph is shown in Figure A. What is the most appropriate next step in his management?
Reassurance and appropriate followup
Use of a bone stimulator
IM nail removal, open reduction internal fixation with bone grafting
A patient sustained a transverse humeral shaft fracture 6 months ago and presently complains of pain and instability at the area of injury. A plain radiograph is shown in Figure A and on exam there is gross motion at the fracture site. What is the most appropriate definitive treatment?
ultrasound therapy to nonunion site
open reduction internal fixation with autologous bone graft
antegrade intramedullary nail
retrograde intramedullary nail