scholarly journals Use of Ultrasound for Diagnosis of Clavicle Fractures in the Emergency Department

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Clavicle Fracture ◽  
Good Alternative ◽  
Plain Radiography ◽  
Emergency Physicians ◽  
Future Studies ◽  
X Ray ◽  
Shoulder Trauma ◽  
Clavicle Fractures ◽  
The Mean

Background: Plain radiography is the method for diagnosing the fracture of the clavicle. The use of US to diagnose clavicle fracture has several advantages when compared to radiography. It could prevent the patient from radiation exposure, especially in vulnerable populations. It may also expedite the diagnosis and decrease the length of stay in the ED. In this study we aimed to discuss the diagnostic success of ultrasonography versus x-ray. Materials and Method: All patients admitted to the emergency department with a shoulder trauma were investigated for their eligibility to be included in the study. A standardized ultrasonography performed by the same investigator to vizualise clavicle from sternal junction through acromial junction. After ultrasonography, plain radiography was performed. Results: The mean age was 45.53 (min = 18; max = 86; SD = 18.791) years and 72.7% were male. Among all patients, 42 clavicula fractures were detected via graphy and 26 (62%) were seen in males and 57 patients with no clavicle fractures. The sensitivity of US to radiographically detected fracture was 92.86% (95%CI, 80.52% to 98.5%), and the specificity was 98.25% (95%CI = 90.61% to 99.96%). The PPV was 97.5% (84.8% to 99.63%) and the NPV was 94.92% (95% CI = 86.23% to 98.23%). Conclusions: Ultrasonography is a good alternative for diagnosing clavicle fracture. Future studies should examine the use of ultrasonography as a method for diagnosing of clavicle fracture by emergency physicians with only basic ultrasonographic training.

scholarly journals Clinical diagnosis of clavicle fractures: a pilot study

CJEM ◽  
2001 ◽  
Vol 3 (02) ◽  
pp. 95-98 ◽  
Author(s):  
Jim Landine ◽  
Robert McGraw ◽  
William Pickett
Keyword(s):  
Pilot Study ◽  
Tissue Injury ◽  
Clavicle Fracture ◽  
Soft Tissue Injury ◽  
X Rays ◽  
Future Studies ◽  
X Ray ◽  
Clavicle Fractures ◽  
High Degree ◽  
Diagnostic Radiography

ABSTRACTObjective:Clavicle fractures are commonly encountered in the emergency department (ED). Our objective was to determine whether emergency physicians can clinically predict the presence and location of a clavicle fracture prior to obtaining x-rays.Methods:Over a 16-month period we prospectively studied ED patients who had injuries compatible with a clavicle fracture. Following clinical examination and prior to obtaining radiographs, ED physicians or senior emergency medicine (EM) residents were asked to predict whether the clavicle was fractured and, if fractured, the location of the fracture. Clinical predictions were later compared to the radiologist’s report.Results:Between April 1999 and August 2000, 184 patients with possible clavicle fracture were seen and 106 (58%) were enrolled. Of these, 94 had an acute fracture, and all 94 fractures were predicted on clinical grounds prior to x-ray. In 6 cases, physicians predicted a fracture but the radiograph was negative. In 6 additional cases, physicians were clinically unsure and the radiograph was negative. Physicians correctly predicted fracture location in 83 of 94 cases (88%; 95% confidence interval [CI], 82%–95%). In the 64 cases where physicians predicted a middle third fracture, they were 100% accurate (95% CI, 95%–100%). Errors made by physicians were conservative; that is, they occasionally predicted fractures in patients with only soft tissue injury, but they did not “miss” existing fractures.Conclusions:The results of this pilot study suggest that ED physicians can clinically predict the presence and location of clavicle fractures with a high degree of accuracy. It may be that x-rays are not always necessary in patients suspected of having a clavicle fracture. Future studies should define the indications for diagnostic radiography in patients with suspected clavicle fractures.

scholarly journals Morphological Associations between the Distal Radioulnar Joint and the Lunate

2017 ◽  
Vol 07 (02) ◽  
pp. 148-155
Author(s):  
Jean-Yves Beaulieu ◽  
Flavien Mauler
Keyword(s):  
Emergency Department ◽  
Distal Radioulnar Joint ◽  
Ulnar Variance ◽  
Mean Values ◽  
Lunate Bone ◽  
Future Studies ◽  
Morphological Variations ◽  
Radioulnar Joint ◽  
The Mean

Background Variations in morphology of the carpal bones have been described. Their implication in wrist disease and specific kinematic features has been recognized, and a better knowledge of these variations is essential. Questions/Purpose To radiographically determine any association between the morphological variations of the distal radioulnar joint (DRUJ) and the lunate bone. Materials and Methods Radiographs of 100 wrists of patients presenting to the emergency department with wrist pain and referred to our outpatient clinic were retrospectively reviewed for DRUJ inclination, ulnar variance, and radiocarpal and midcarpal morphology of the lunate. Results There were 51 females and 49 males, mean age 51.2 years (range: 21–94). There was a statistically significant association between the DRUJ inclination and the morphology of the radiocarpal side of the lunate (p < 0.001). The mean values of ulnar variance changed according to DRUJ inclination and the radiocarpal side of the lunate (p < 0.001) but not according to the midcarpal side of the lunate. There was no significant association between the morphology of the DRUJ and the midcarpal side of the lunate or between the midcarpal and the radiocarpal morphology of the lunate. Conclusion This study demonstrated a statistically significant association at the radiocarpal level between the DRUJ inclination, ulnar variance, and the morphology of the lunate. No association was found with the morphology of the midcarpal side of the lunate. Accordingly, a classification of these carpal associations is proposed, highlighting seven main wrist configurations. Clinical Relevance These associations can guide future studies of wrist kinematics.

scholarly journals Push-Dose Pressors During Peri-intubation Hypotension in the Emergency Department: A Case Series

2021 ◽  
Vol 5 (4) ◽  
pp. 390-393
Author(s):  
Abdullah Bakhsh ◽  
Leena Alotaibi
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Mean Arterial Pressure ◽  
Side Effects ◽  
Case Series ◽  
Rapid Sequence Intubation ◽  
Emergency Physicians ◽  
Rapid Sequence ◽  
Lethal Complications ◽  
The Mean

Introduction: Emergency physicians frequently encounter critically ill patients in circulatory shock requiring definitive airway procedures. Performing rapid sequence intubation in these patients without blood pressure correction has lethal complications. Questioning the efficacy and fearing side effects of push-dose pressors (PDP) has created an obstacle for their use in the emergency department (ED) setting. In this case series we describe the efficacy and side effects of PDP use during peri-intubation hypotension in the ED. Case series: We included 11 patients receiving PDPs in this case series. The mean increase in systolic blood pressure was 41.3%, in diastolic blood pressure 44.3%, and in mean arterial pressure 35.1%. No adverse events were documented in this case series. Conclusion: The use of push-dose pressors during peri-intubation hypotension may potentially improve hemodynamic status when used carefully in the ED.

A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF CLOSED DISPLACED MID- SHAFT CLAVICLE FRACTURES TREATED WITH INTRAMEDULLARY TITANIUM ELASTIC NAIL SYSTEM

2021 ◽  
pp. 81-83
Author(s):  
S. Kishore Babu ◽  
Pamu Bala Avinash ◽  
S. Rajeswara Rao
Keyword(s):  
Minimally Invasive ◽  
Clavicle Fracture ◽  
Invasive Procedure ◽  
Routine Work ◽  
Elastic Nail ◽  
Clavicle Fractures ◽  
The Mean ◽  
Average Size ◽  
A Prospective Study

Background: Clavicle fracturesare common injuries in young individuals, mostly related to sports and road trafc accidents. In contrast, in children and elderly, they are related to falls, and account for approximately 2.6% of all fractures. A middle-third shaft clavicle fracture is the most common site( 80% of all clavicle fractures). Methodology: A study was carried out in 30 patients with simple middle third clavicular fractures who weretreated with closed intra-medullary xation with TENS nailing. Postoperatively range ofmovements,ability to get back to routine work were assessed and noted. Results :At the end of the study, 30 patients in the follow-up group with 21 male and 9 femalepatients taken. The mean age was 34.9 years noted. The mean time intervalbetween injury and surgery was 3.55 days (range 1–6 days). For all the patients the clinical andradiological union achieved at a mean of 8.6 weeks (Range, 6-12 weeks). seventeen out of the 30 patients had closednailing while thirteen patients (43%) required open reduction of their fracture. The average size of theexible titanium nail used was 2.5 mm (range, 2 - 3mm). Conclusion :The present study advise the use of minimally invasive antegradetitanium elastic nail for xation of displaced midshaft clavicle fractures as a safe minimally invasive procedure.

scholarly journals Pneumothorax Caused by an Isolated Midshaft Clavicle Fracture

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Najla Feriani ◽  
Hassen Ben Ghezala ◽  
Salah Snouda
Keyword(s):  
Emergency Department ◽  
Clavicle Fracture ◽  
Physical Examinations ◽  
Clavicle Fractures

Patients with isolated clavicle fractures are frequent in the emergency department. However, unusual clavicle fractures complications, such as pneumothorax, are rare. Previous reports indicated that all pneumothorax cases were treated via performing thoracostomy. Conservatively, the treatment of the clavicle fracture, like in our case, was successful. Despite the fact that isolated clavicle fractures rarely cause complications and generally heal with immobilization, serious complications may occur requiring urgent treatment. It has been proven that physical examinations, with particular attention to the neurovascular and chest examinations, and radiographs of the clavicle are necessary to prevent overlooking these potentially dangerous complications.

scholarly journals EVALUATION THE SIGN OF UNION, DURATION OF SURGERY AND POST-OPERATIVE SKIN COMPLICATION IN MID SHAFT CLAVICLE FRACTURE.

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Sanjay S. More ◽  
Dr. Rahul Bade ◽  
Dr. Divyang Parmar
Keyword(s):  
Operative Time ◽  
Clavicle Fracture ◽  
Minimal Invasive ◽  
Open Technique ◽  
Group A ◽  
Clavicle Fractures ◽  
The Mean ◽  
Group B ◽  
Radiological Union

INTRODUCTION: It is impossible to support and immobilize a fracture of middle 3rd of clavicle in an adult by external means with figure-of-eight bandages. Clavicle fractures accounts for approximately 2.6% of all fractures in adults2 10% to 15% in children and comprise about 30 -40% of all shoulder girdle injuries and 5% fractures occurs in medial end. The goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. Definitive indications for acute surgical intervention include skin tenting, open fractures, the presence of neurovascular compromise, multiple trauma, or floating shoulder. Outside of these indications, the management of displaced fractures of the mid shaft (Edinburgh type 2B) remains somewhat controversial. Recent literature is challenging the traditional belief that mid- shaft clavicle fractures uniformly heal without functional deficit.   MATERIAL AND METHODS: Patients included were cases of mid shaft clavicle fractures. 30 patients with mid shaft clavicle fractures were included in the study.All patients above 18 years of age were included in the study falling into Robinson’s type 2 B1 (Mid shaft simple displaced and single butterfly fragment fracture), type 2 B2 (Mid shaft segmental fracture) classification. The patients were selected randomly and were divided in the following two groups of 15 patients each: Group A: 15 patients treated by anatomical locking compression plate (LCP) by open technique. Group B: 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. All patients were operated as early as possible once the patient was declared fit for the surgery by the physician. Open reduction and internal fixation with LCP was done. RESULTS: A total of 30 patients were included in the study. In group A 15 patients treated by anatomical locking compression plate (LCP) by open technique and in group B 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. In Group A, 7 (46.7%) patients had operative time of 80-100 minutes whereas 6 (40%) and 2 (13.3%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 104.9 ± 13.52mins. In Group B, 6 (40%) patients had operative time of 80-100 minutes whereas 8 (53.4%) and 1 (6.6%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 106.5 ± 11.72mins. The mean duration for radiological union in Group A was 12.7 ± 4.61 weeks. Majority of the patients (60%) achieved radiological union in <12 weeks while 6 (40%) patients achieved union in 12-24 weeks. In Group B, majority of the patients (66.7%) achieved radiological union in <12 weeks while 5 (33.3%) patients achieved union in 12-24 weeks. The mean duration for radiological union in Group B was 12.1 ± 6.68 weeks. CONCLUSION: MIPOs can used to preserve the biology at the fracture site, to maximise the healing potential of the bone, and to facilitate early and pain free recovery and MIPPO technique with the application of LCP offered an ideal combination in terms of bone fixation and soft-tissue sparing.

scholarly journals Clinical outcomes of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fracture

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gui Wu ◽  
Yao-qing Chen ◽  
Chun-yong Chen ◽  
Zhang-xiong Lin ◽  
Qi-yang Xie ◽  
...  
Keyword(s):  
Average Length ◽  
Plate Fixation ◽  
Demographic Data ◽  
Clavicle Fracture ◽  
Bone Fragments ◽  
Comminuted Fractures ◽  
Clavicle Fractures ◽  
The Mean ◽  
The Stability

Abstract Background Free bone fragments were difficult to be fixed in many comminuted midshaft clavicle fractures, and the absence of cortical alignment in comminuted fractures had direct influence on the stability of fixation. This survey was performed to assess the efficacy of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fractures. Methods Between 2013 and 2018, all patients with comminuted midshaft clavicle fractures treated with doubled-suture Nice knot augmented plate fixation were retrospectively reviewed and included in this research. Demographic data of the patients, characteristics of the fractures, intraoperative parameters and follow-up data of the patients were evaluated and summarized. Results A total of 56 patients were included in this study. The mean follow-up time was 25.6 months (range, 12–60 months). The number of male patients was 38 (67.9 %) and of the female patients was 18 (32.1 %). The average age of all patients was 47.89 ± 16.5 years. The mean time of surgery was 85.6 ± 24.0 min. The average length of incision was 9.2 ± 1.9 cm. The number of doubled-suture Nice knot applied ranged from 1 to 5 knots. All the patients reached bone union after the treatment. There was no implant failure or neurovascular injury observed. And most of the patients showed good functional outcome. Conclusions The doubled-suture Nice knot could provide reliable fixation for small bone fragments in comminuted clavicle fractures. Combination of the doubled-suture Nice knot and plate screws fixation was a safe and effective method in comminuted midshaft clavicle fractures treatment.

scholarly journals P017: A time-driven activity-based costing method to estimate health care costs in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83
Author(s):  
S. Berthelot ◽  
M. Mallet ◽  
L. Baril ◽  
P. Dupont ◽  
L. Bissonnette ◽  
...  
Keyword(s):  
Emergency Department ◽  
Unit Cost ◽  
Emergency Physicians ◽  
Activity Based Costing ◽  
Process Maps ◽  
X Ray ◽  
Resource Unit ◽  
Care Activity ◽  
The Cost ◽  
Care Costs

Introduction: Poor physicians’ knowledge of health care costs has been identified as an important barrier to improving efficiency and reducing overuse in care delivery. Moreover, costs of tests and treatments estimated with traditional costing methods have been shown to be imprecise and unreliable. We estimated the cost of frequent care activities in the emergency department (ED) using the time-driven activity-based costing (TDABC) method. Methods: We conducted a TDABC study in the ED of the CHUL, Québec city (77000 visits/year). We estimated the cost of all potential care activities (e.g. triage) provided to adult patients with selected urgent (e.g. pulmonary sepsis) and non urgent (e.g. urinary tract infection) conditions frequently encountered in the ED. Following Lean management principles, process maps were developed by a group of ED care providers for each care activity to identify human resources, supplies and equipment involved, and to estimate the time required to complete each process. Resource unit cost (e.g. cost per minute of a nurse) and overhead rate were calculated using financial information from fiscal year 2015-16. Estimated cost of each care activity (e.g. chest X-ray) including physicians’ charges was calculated by summing overhead allocation and the cost of each process (e.g. disinfection of the X-ray machine) as obtained by multiplying the resource unit cost by the time for process completion. Results: Process maps were developed for 14 conditions and 68 ED care activities. We estimated the costs of activities (CAN$) related to nursing (e.g. urinalysis and culture triage ordering $14.70), clerk tasks (e.g. patient registration $3.40), physicians (e.g. FAST scan $20.90), laboratory testing (e.g. CBC $6.30), diagnostic imaging (e.g. abdominal CT scan $146.50), therapy (e.g. 5 mg of iv morphine $20.40), and resuscitation (rapid sequence intubation with ketamine and succinylcholine $146.40). Overall, emergency physicians’ charges, personnel salaries and overheads accounted for 38%, 22% and 16% of all ED care costs, respectively. Conclusion: Our results represent an important step toward increasing emergency physicians’ awareness on the real cost of their interventions and empowering them to adopt more cost-effective practice patterns.

scholarly journals Functional outcome of plating for displaced middle third clavicle fractures in adults

2018 ◽  
Vol 8 (3) ◽  
pp. 57-63
Author(s):  
Jyoti Sitaula ◽  
Ananda Prasad Regmi ◽  
Akesh Prajapati ◽  
Suresh Bahadur Thapa ◽  
Bishnu Dev Sharma ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Constant Score ◽  
Clavicle Fracture ◽  
Reconstruction Plate ◽  
Superior Surface ◽  
Clavicle Fractures ◽  
The Common ◽  
The Mean ◽  
One Year

Introduction: Clavicle fractures are the common fractures around the shoulder. Conservative treatment is as­sociated with higher incidence of nonunion. We conducted this study to assess the functional outcome of plat­ing for displaced middle third clavicle fractures. Methods: This prospective study included 60 patients with displaced middle third clavicle fractures from April 2016 to March 2017. Fixation was done with a 3.5 mm reconstruction plate placed at the superior surface of the clavicle. Patients were followed-up for a minimum of one year. Functional outcome was assessed using Constant shoulder score. Results: There were 48 male and 12 female patients with a mean age of 33.17 years (range 18-74 years). The average follow-up period was 17.82 months. All fractures united at an average of 5.35 months. The mean Constant score at final follow-up was 89.12. There were two superficial infections and three implant failures. Conclusion: We conclude that treat­ment of displaced middle third clavicle fracture with plate gives good results.

The incidence of medial end clavicle fractures is higher than had previously been considered

2020 ◽  
pp. 175857322092312
Author(s):  
Nawfal Al-Hadithy ◽  
Zakir H Khokher ◽  
Niel Kang ◽  
Lee Van Rensburg ◽  
Graham Tytherleigh-Strong
Keyword(s):  
Emergency Department ◽  
Clavicle Fracture ◽  
Epidemiological Studies ◽  
Elbow Fracture ◽  
X Rays ◽  
Level Of Evidence ◽  
Fracture Clinic ◽  
Clavicle Fractures ◽  
Virtual Fracture Clinic ◽  
Tomography Scan

Background Previous X-ray epidemiological studies have estimated the incidence of medial end clavicle fractures to account for 2–3% of all clavicle fractures. Materials and methods At our institution X-rays of every patient attending the Emergency Department are reviewed at a Virtual Fracture Clinic by a Consultant Orthopaedic Surgeon. Patients with a fracture are referred to the Shoulder and Elbow Fracture Clinic. Patients without a fracture are contacted and, if there are on-going concerns, are referred to the Shoulder and Elbow Fracture Clinic. Over an 18-month period we identified every patient that attended our Emergency Department that had sustained a clavicle fracture. Results In total 558 clavicle fractures were identified (139 (24.9%) – lateral, 360 (64.5%) – middle, 59 (10.6%) – medial). Of the 59 medial end fractures, 31 (52.5%) were identified on presentation at the Emergency Department, 13 (22%) at the Virtual Fracture Clinic, 6 (10.2%) on computed tomography scan at the Shoulder and Elbow Fracture Clinic and 9 (15.3%) were admitted directly to the trauma unit. Conclusion The results of this study suggest that the incidence of medial end clavicle fractures in the general population is higher than had previously been considered. Level of evidence IV

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