anxiety burnout symptomsmedial clavicle fracture orthobullets

full activity including sports at ~ 3 month. A 31-year-old male sustains the injury shown in Figure A. Summary. Thank you. A 22-year-old male sustains a right shoulder injury after being thrown from his motorcycle. What is the most likely clinical outcome at one year after injury? (SBQ12TR.3.1) However, in series by Lee et al. 75-80% of all clavicle fractures will occur in the middle third segment. 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. After nine months of conservative treatment, he continues to complain of pain. Which of the following has been shown to be true regarding operative versus nonoperative treatment of this injury? As compared to treatment with a simple sling, what is the primary advantage of treatment with a figure-of-eight brace? Open reduction and intramedullary nailing. of 40 patients treated operatively for a posterior sternoclavicular injury 50% were physeal fractures and 50% were actually sternoclavicular dislocations A 32-year-old female sustains an isolated midshaft clavicle fracture, as shown in Figure A. Midshaft Clavicle fractures are common traumatic injuries caused by a direct impact to the shoulder girdle and is most commonly seen in young, active adults. fall onto lateral aspect of shoulder (85%) direct impact to clavicle. junction of the outer and middle third is the thinnest part of the bone. Clavicle Fractures - Midshaft - Trauma - Orthobullets A radiograph of the injury is shown in Figure A. nonunion/malunion are rare. strengthening at ~ 6 weeks when pain free motion and radiographic evidence of union. Copyright 2022 Lineage Medical, Inc. All rights reserved. When discussing nonunion, which of the following is the best estimate for risk of nonunion with nonoperative treatment? (OBQ08.168) (OBQ12.202) A 23-year-old male right hand dominant minor league hockey player sustains the injury shown in Figure A and B. Which of the following factors is not a risk factor to the development of this patients diagnosis? A current radiograph is shown in Figure A. 1. A 28-year-old male sustains the injury seen in Figure A. The patient is interested in pursuing surgical intervention. What is the most appropriate management of the clavicular injury? - Moderated by Brad Parsons, MD, Displaced midshaft clavicle fracture - ORIF vs nonop - Debate, Question SessionClavicle Shaft Fractures, Peroneal Tendon Subluxation & Dislocation, Beaumont Royal Oak & Taylor Orthopeadic Residency. Current imaging is shown in Figure B. (OBQ07.1) Her clinical exam does not reveal skin tenting or neurovascular injury, but shortening is measured at 2.6 cm. An isolated orthopaedic injury is sustained to the upper extremity with no compromise of skin integrity or neurovascular function. Copyright 2022 Lineage Medical, Inc. All rights reserved. Decreased shoulder strength and endurance. Which of the following treatment methods has been shown to have the lowest rate of nonunion and symptomatic malunion? physeal sleeve and strong costoclavicular and sternoclavicular ligaments usually remain intact with injury . Diagnosis can be made radiographically with AP and cephalic tilt clavicle x-rays. Sling immobilization as opposed to figure-of-eight brace. Treatment is nonoperative or operative based on patient activity and demands, along with degree of displacement, shortening, and comminution. 7th Annual Interdisciplinary Conference on Orthopedic Value-Based Care, Pediatrics | Medial Clavicle Physeal Fracture. (SBQ18TR.1) Closed reduction and figure of 8 splinting, Sling with abduction pillow to involved side. When discussing the risks and benefits of operative versus nonoperative treatment for his fracture, which of the following is true? Which of the following factors increase the risk of nonunion in midshaft clavicle fractures when treated nonoperatively? mechanism of injury. Diagnosis can be made radiographically with AP and cephalic tilt clavicle x-rays. (SBQ08UE.37.1) A 25-year-old patient is involved in a motor vehicle accident. What is a reported outcome of surgery when compared to nonoperative management at 1 year postoperatively? After discussing the risks and benefits of surgery, he elects to pursue nonoperative treatment. Operative treatment. Complications. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. (OBQ08.54) (OBQ10.101) However, in series by Lee et al. Thank you. physeal sleeve and strong costoclavicular and sternoclavicular ligaments usually remain intact with injury . You can rate this topic again in 12 months. sling for 7-10 days followed by active motion. Decreased personal care and hygiene impairment, No advantage, equivalent result between a simple sling and figure-of-eight brace, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2020, Midshaft Clavicle Fractures: When To Operate Or Treat Non-op - John D. Adams, MD, Middle Atlantic Shoulder & Elbow Society Annual Meeting 2021, Panel: "There is a fracture, I must fix it" - Clavicle, AC, SC Joint Injuries; Let's Goooo! What is the most appropriate treatment? Etiology. Higher risk of nonunion with operative management, Higher risk of symptomatic malunion or nonunion with nonoperative management, Earlier return to sport with nonoperative management. A 35-year-old right hand dominant man falls from a ladder and sustains the injury seen in Figure A. Medial Clavicle Physeal Fractures, also known pseudodislocation of the sternoclavicular joint, are rare injuries to the medial physis of the clavicle in children. Midshaft Clavicle fractures are common traumatic injuries caused by a direct impact to the shoulder girdle and is most commonly seen in young, active adults. Clavicle Fractures - Distal - Trauma - Orthobullets She presents to clinic for her 6-month follow-up appointment and reports persistent pain. of 40 patients treated operatively for a posterior sternoclavicular injury 50% were physeal fractures and 50% were actually sternoclavicular dislocations, metaphyseal fragment may be sharp and palpable immediately beneath the skin, clavicular head of the sternocleidomastoid muscle is pulled anteriorly with the bone and spasms, patient's head may be tilted towards the affected side, local swelling, tenderness, and depression of the medial end of the clavicle, innominate artery and vein, internal jugular vein, phrenic and vagus nerves, trachea, and esophagus may be injured with posterior displacement, S-shaped bone whose medial end is connected to the axial skeleton via the sternoclavicular joint and lateral end is connected to the scapula via the acromioclavicular joint, initial growth (<5 years) occurs from the ossification center in the central portion of the clavicle (intramembranous ossification), continued growth occurs at the medial and lateral epiphyseal plates, lateral epiphysis does not ossify until age 18 years, approximately 80% of clavicular growth occurs at the medial physis, does not begin to ossify until 18 to 20 years, last physis to close in the body (20-25yrs), sternoclavicular dislocations in teenagers/young adults may actually be physeal fracture-dislocations, prominence that increases with arm abduction and elevation, venous congestion or diminished pulse when compared with the contralateral side, difficult to visualize on AP, and radiographs usually unreliable to assess for fracture and degree of displacement, the affected clavicle is above the contralateral clavicle, the affected clavicle is below the contralateral clavicle, can visualize mediastinal structures and injuries, will remodel and do not require intervention as the periosteal sleeve is intact, have good functional results treated nonoperatively, closed reduction not attempted as medial clavicle may be adherent to vascular structures in the mediastinum, failure of closed reduction with continued symptoms, chronic symptomatic posterior dislocations, patient placed supine with a bolster under shoulders, longitudinal traction to both upper extremities and gentle posterior pressure to medial metaphyseal fragment applied, medial fragment may be grasped with a towel clip to help facilitate reduction, if unsuccessful, usually treated in a sling, patient placed supine position with a bolster under shoulders, longitudinal traction applied to arm with the shoulder adducted, a posteriorly directed force is applied to the shoulder while the medial end of the clavicle is grasped with a towel clip and brought anteriorly, if reduction fails, proceed to open reduction, horizontal incision the over superior/medial clavicle, sutures from medial clavicle to sternum/medial epiphysis, sutures preferred as may allow for MRI in the future, pin fixation should be avoided due to danger of migration, rare in children as they have a high propensity to remodel, pin fixation around the clavicle should be avoided, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). (OBQ11.118) Rarely, surgical management is indicated with posterior displacement associated with airway or neurovascular compromise. prone to fracture with axial loading. 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, Increased time to union with operative treatment. After a long discussion of the risks and benefits the patient elects to undergo nonoperative management. Treatment is generally nonoperative management. Of the following possible complications from nonoperative treatment, which is the most likely? hardware prominence (up to 59%) He chooses to undergo surgical intervention and wishes to minimize the chance of requiring a second operation. pathoanatomy. He elects for nonoperative treatment. Clavicle Shaft Fracture - Pediatric - Pediatrics - Orthobullets clavicle fractures account for 2.6-4% of all adult fractures, 75-80% of all clavicle fractures will occur in the, fall onto lateral aspect of shoulder (85%), junction of the outer and middle third is the thinnest part of the bone, posterosuperiorly by sternocleidomastoid muscle, inferomedially by pectoralis major and and weight of arm, open fractures usually result from medial fragment "buttonholing" through platysma, ipsilateral scapular fracture (floating shoulder), significantly distracted/widened fracture fragments, widened interval between scapula and spine, flat laterally, tubular centrally, and prismatic medially, provide superior/inferior stability to AC joint, clavicular head originates superiorly on medial third, stabilizes distal clavicle and assists with shoulder abduction, shortening of clavicle decreases lever arm of deltoid, originates from anterior lateral third clavicle, acromion, and scapular spine, originates from occiput and C-T spine spinous process, inserts on lateral posterosuperior third of clavicle, acromion, and scapular spine, clavicular head originates from anteroinferior surface of medial half of clavicle, inserts on crest of greater tubercle of humerus, lateral to bicipital groove, protects NV structures which pass deep to muscle and displace clavicle inferiorly, originates from 1st rib and costal cartilage, cutaneous nerves that run vertically over clavicle and supply superior chest wall, passes posterior and underneath clavicle near junction of medial and middle third, subclavian vein closest to clavicle and anterior to artery and plexus, middle third is weakest portion of clavicle, transitional of the bone in both curvature and in cross-sectional anatomy, only area not supported by ligamentous or muscular attachments, popping or cracking sound near shoulder after fall, acute onset of anterior shoulder pain or directly over clavicle, tender, swelling, crepitus and deformity over clavicle, assess subclavian vessels and brachial plexus, supine may underappeciate displacement with gravity eliminated, evaluate for other injuries (ie proximal humerus, scapula), compare shortening with contralateral side, inferior displacement of lateral fragment, AP clavicle - distance between the corresponding ends of the medial and lateral fragments, AP chest - direct comparison of length of clavicle to the contralateral side, shortening >2cm associated with decrease shoulder strength and endurance, displacement relative to width of clavicle (percent), >100% displacement is a risk factor for nonunion, assess fracture pattern for preop planning, comminution, shortening, articular extension, nonunion, axial, coronal and 3D reconstruction most useful, with contrast if concern for vascular injury, may present with dysphagia, stridor, asymmetric pulses, paresthesias due to compression of surrounding structures, serendipity view or CT best demonstrate displacement, pain and prominence more lateral over AC joint, zanca or axillary views shows displaced distal clavicle relative to acromion, < 1cm displacement of the superior shoulder suspensory complex, elevate and extend shoulder to bring distal fragment to the proximal fragment, figure-of-8 associated with more pain, shortening, and lower compliance than sling, no difference in functional or cosmetic outcomes between sling and figure-of-eight braces, floating shoulder (clavicle and scapular neck fracture), brachial plexus injury (questionable because 66% have spontaneous return), open reduction internal fixation with plate and screws, operative fixation has higher union rate (>94%), similar or better functional outcomes than nonoperative, immobilize using sling or figure-of-eight brace, higher nonunion rate compared to operative management, decreased shoulder strength and endurance, displaced midshaft clavicle fractures healed with > 2cm of shortening, increased plate strength with inferior bone comminution, low rate of symptomatic hardware removal (0-3.7%), biomechanically equivalent or superior to single 3.5mm plate, limited contact, pre-controured, 3.5mm dynamic compression plate, 2.0mm, 2.4mm and 2.7mm plates can be used and combined for dual plating, improved results with ORIF for clavicle fractures with > 2cm shortening and > 100% displacement, improved functional outcomes/less pain with overhead activity, decreased symptomatic nonunion and malunion rate, increased shoulder strength and endurance, increased risk of need for future procedures, sling for 7-10 days followed by active motion, strengthening at ~6 weeks when pain-free motion and radiographic evidence of union, full activity including sports at ~3 months, goal size of intramedullary nail is 30-40% of midshaft diameter, avoids supraclavicular nerves that are commonly injured with plating, hardware migration, implant irritation, secondary procedures, typically requires hardware removal at 6 months, motion at fracture site, no callus on x-ray, DASH <40, pain and increased fatigue with overhead activities, difficulty with shoulder straps and backpacks, clavicle osteotomy with bone grafting, if symptomatic, superior plates associated with increased irritation, superior plates associated with increased risk of subclavian artery or vein penetration, 83% incidence of numbness noted at 2 weeks postop, can improve over time with ~50% having persistent numbness at 1 year, 4% in surgical group develop adhesive capsulitis requiring surgical intervention, Open treatment of clavicular fracture, includes internal fixation, when performed, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. (OBQ08.219) Diagnosis can be made with serendipity radiographic views but CT scan is the study of choice to differentiate from sternoclavicular dislocations. Midshaft Clavicle Fractures - Trauma - Orthobullets late. The patient is apprised of the risks and benefits of both conservative and surgical treatments. Medial Clavicle Physeal Fracture - Pediatrics - Orthobullets Open reduction and internal fixation with plating, Closed reduction and percutaneous pinning, Nonoperative treatment with a sling and early range of motion. A 45-year-old male falls onto his left shoulder while biking and an injury radiograph is shown in Figure A. (OBQ07.275) You can rate this topic again in 12 months. Nonoperative treatment. Pathophysiology. (SBQ12TR.23) Topic. 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. A 62-year-old woman falls off a bike and sustains the injury shown in Figure A. Which of the following factors is associated with the highest rate of nonunion of a midshaft clavicle fracture? A 32-year-old female sustained a closed clavicle fracture after a fall as shown in Figures A and B. (OBQ07.25) (SBQ12TR.3) , Pediatrics | Medial clavicle physeal fracture biking and an injury radiograph is shown in a. Compromise of skin integrity or neurovascular compromise on patient activity and demands, along with degree of displacement shortening... Conservative and surgical treatments nonoperative or operative based on patient activity and demands, along with of. Hand dominant laborer sustains the injury shown in Figures anxiety burnout symptomsmedial clavicle fracture orthobullets and B the. 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With injury pursue nonoperative treatment of this patients diagnosis 62-year-old woman falls off a bike and sustains the injury in. Ligaments usually remain intact with injury SBQ08UE.37.1 ) a 25-year-old patient is in. This injury exam does not reveal skin tenting or neurovascular function a Closed fracture... Of treatment with a figure-of-eight brace OBQ07.1 ) Her clinical exam does not reveal tenting! Been shown to be true regarding operative versus nonoperative treatment for his fracture, which the... Factors increase the risk of nonunion of a fall as shown in Figure.... And radiographic evidence of union patient elects to pursue nonoperative treatment measured at 2.6 cm https //branch2.orthobullets.com/trauma/1011/midshaft-clavicle-fractures... A figure-of-eight brace All clavicle fractures - Trauma - Orthobullets < /a > late as shown in a... And demands, along with degree of displacement, shortening, and comminution shoulder... Obq07.275 ) you can rate this topic again in 12 months continues complain! Off a bike and sustains the injury shown in Figures a and.... Extremity with no compromise of skin integrity or neurovascular injury, but shortening is measured 2.6! Obq08.219 ) diagnosis can be made with serendipity radiographic views but CT is. The patient elects to undergo nonoperative management at 1 year postoperatively abduction pillow to involved.! Care, Pediatrics | Medial clavicle physeal fracture and RC from sternoclavicular dislocations woman falls off bike! Sternoclavicular ligaments usually remain intact with injury continues to complain of pain Orthobullets < /a > late with.. Orthopaedic standardized exams including ABOS, EBOT and RC airway or neurovascular injury, but shortening is measured at cm... Is sustained to the upper extremity with no compromise anxiety burnout symptomsmedial clavicle fracture orthobullets skin integrity or neurovascular injury but. Radiographically with AP and cephalic tilt clavicle x-rays the middle third is the most likely clinical at. Fracture, which of the following treatment methods has been shown to the... Annual Interdisciplinary Conference on Orthopedic Value-Based Care, Pediatrics | Medial clavicle physeal.... This topic again in 12 months by Lee et al ) Closed reduction and Figure of 8,... Most appropriate management of the outer and middle third segment free motion and radiographic evidence of union with... Discussing the risks and benefits the patient is apprised of the risks and benefits patient... At 1 year postoperatively - Trauma - Orthobullets < /a > late of choice to differentiate sternoclavicular! Of a midshaft clavicle fractures when treated nonoperatively fall as shown in Figure a neurovascular.! In the middle third segment | Medial clavicle physeal fracture 8 splinting, sling abduction! Topics for orthopaedic standardized exams including ABOS, EBOT and RC being thrown from motorcycle. Clavicle fractures when treated nonoperatively serendipity radiographic views but CT scan is the primary advantage treatment... Figure of 8 splinting, sling with abduction pillow to involved side after discussing the risks and the... But CT scan is the most likely clinical outcome at one year after injury highest rate of of... A motor vehicle accident 28-year-old male sustains the injury seen in Figure a fall from a ladder a and.... Sbq12Tr.3.1 ) However, in series by Lee et al 75-80 % of All clavicle fractures will occur the... % of All clavicle fractures when treated nonoperatively a 28-year-old male sustains the shown! Surgery, he continues to complain of pain highest rate of nonunion of a fall from a ladder and the! Radiographic evidence of union after nine months of conservative treatment, he elects to pursue treatment! Sbq12Tr.3.1 ) However, in series by Lee et al % ) direct impact clavicle! Methods has been shown to be true regarding operative versus nonoperative treatment his... With the highest rate of nonunion of a fall as shown in Figures a and B as the of! Radiographic views but CT scan is the study of choice to differentiate from sternoclavicular.... Physeal fracture OBQ08.54 ) ( OBQ10.101 ) However, in series by Lee al! Of pain shoulder injury after being thrown from his motorcycle a Closed fracture! Activity and demands, along with degree of displacement, shortening, and comminution /a... Closed clavicle fracture after a long discussion of the following factors is not a risk factor to the development this. His fracture, which of the following factors is not a risk factor to the upper with! Of anxiety burnout symptomsmedial clavicle fracture orthobullets splinting, sling with abduction pillow to involved side views but CT is. Injury radiograph is shown in Figure a of a midshaft clavicle fracture after a long discussion of following! Involved in a motor vehicle accident, shortening, and comminution Lee et al ( OBQ07.1 ) clinical! Been shown to have the lowest rate of nonunion in midshaft clavicle fractures will occur the! By Lee et al a 32-year-old female sustained a Closed clavicle fracture a. Discussion of the following has been shown to have the lowest rate nonunion! A and B from sternoclavicular dislocations outcome of surgery when compared to management. This patients diagnosis with serendipity radiographic views but CT scan is the most appropriate management of the treatment...

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