Can you answer this daily question from our Free QBank correctly?
A 60-year-old male with a history of diabetes presents to the trauma bay after sustaining a ground-level fall onto his right arm. His injury films are shown in Figures A and B. He is treated conservatively with closed reduction and his post-reduction radiographs are shown in Figures C and D. At 6 weeks followup he presents with persistent fracture site motion. His current imaging studies are shown in Figures E and F. Which of the following is the best next step in management?
1. Adjust Sarmiento brace and repeat followup in 3 weeks
2. Continue current management for another 6 weeks and then discontinue brace
3. Proceed with surgical management at this time
4. Continue current management for another 6 weeks and if no evidence of clinical union, proceed with surgical management
5. Discontinue sarmiento brace and allow for progressive weight-bearing at this time
QID: 214153
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¿Puedes responder correctamente a esta pregunta diaria de nuestro Free QBank? Un hombre de 60 años con antecedentes de diabetes se presenta en la sala de traumatología después de sufrir una caída a nivel del suelo sobre su brazo derecho. Las radiografías de su lesión se muestran en las Figuras A y B. Se le trata de forma conservadora con reducción cerrada y sus radiografías posteriores a la reducción se muestran en las Figuras C y D. A las 6 semanas de seguimiento presenta movimiento persistente en el sitio de la fractura. Sus estudios de imágenes actuales se muestran en las Figuras E y F. ¿Cuál de los siguientes es el mejor próximo paso en el manejo? 1. Ajuste el corsé de Sarmiento y repita el seguimiento en 3 semanas 2. Continúe con el tratamiento actual durante otras 6 semanas y luego descontinúe el corsé 3. Continúe con el tratamiento quirúrgico en este momento 4. Continúe con el tratamiento actual durante otras 6 semanas y si no hay evidencia de unión clínica, proceder con el manejo quirúrgico 5. Suspender la ortesis de sarmiento y permitir el soporte de peso progresivo en este momento QID: 214153 **La respuesta se publicará en 24 horas. #orto #cirugíaortopédica #ortopedia #cirujanoortopédico #ortopedia #ortopedia #ortopedia #ortholife #orthobullets #orthresidents #orthresident #orthresidency #medicalschool #medicalstudent #medstudent #doctor #medical
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Surgery with open reduction and long anatomic plate fixation, prepared Crista ilaca graft. 3.
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ORIF with locking nail and bone graft
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3, ORIF
3- ORIF
3 and don’t treat this pattern nonop
ORIF
The preferred response is:
3. Proceed with surgical management at this time
The patient has a proximal 1/3rd humeral shaft fracture with persistent fracture site motion after 6 weeks of conservative management. Given the significant risk of nonunion, he should be offered surgical management at this time.
The management of humeral shaft fractures remains very controversial. Conservative management with coaptation splint followed by Sarmiento bracing is still considered the standard of care in the majority of humeral shaft fractures. Union rates approach 80-90% with conservative management with the exception of certain fracture patterns more prone to nonunion (proximal 1/3rd shaft fractures, fracture-site distraction, and transverse fracture patterns). The decision to abort conservative management and convert to surgical fixation should be based on physical exam, patient symptoms, and radiographic findings. Persistent fracture site motion at 6 weeks is considered to be very highly predictive of progressing to nonunion and surgical management should be recommended for such patients.
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