This 10-year old girl fell from a horse on her left shoulder. What would be your treatment ? Some colleagues express controversial opinions, although at a glance it seems to be an easy case.
Manipulate it under GA to correct the varus and then give an abduction brace for 3 weeks.
A potential simple collar and cuff allowing gravity to act and potentially improve the varus. Definitely not an operation. GA may displace the fracture as muscles are not "bracing" the fracture and manipulation may become unwillingly slightly "generous". Remodelling will happen.
On top of this care has to be taken for her clavicular fracture with limited movements at the time of rehabilitation.
There is a high potential of remodelling. I would go with Velpeau bandage for 2 weeks and then start ROM exercises.
Dear Dr. Akman, 2 weeks seem to me a short time for immobilization. I would prefer 4 weeks because 2 weeks coincides with the time for rarefication and the risk for secondary displacement is really present.
Dear Dr. Tanchev. That's my typographical mistake. I intended to type 4 weeks also.
Best regards.
A simple shoulder immobiliser will do good as good union is expected.
I saw many of this type of fractures while in the Navy in active young men. For a ten year old girl I would suggest a collar and cuff for one to two weeks then convert to a Velpeau bandage for another 4 to 6 weeks. The gravity might help initially then more immobilization till healing.
VELPEAU or ZIMMER splint for 3-4 weeks, no more. There is a hight potential of remodeling and the deformation is already limited... No surgery, no reduction, nothing except a simple immobilization for pain...
All the best!
Just immobilization. This kind of fracture at 10 yrs of age is going to heal smoothly and no surgery is required. After 1 week take a new X-ray just to be sure no secondary displacement occurs (rare). Immobilization for 4 weeks
I agree on the xonservative management suggestion since alignememt of fracture fragments is amply acceptable. In case secondary displacement occurs I would probably go for closed reduction and retrograde pinning with 2 or 3 1.8 mm K-wires.
Simply arm Slings or Shoulder Sling or Shoulder Immobilizer (Velpeau support) for 3 or 4 weeks. Maybe X-ray at 1 week for check correct reduction (avoid secondary displacement)
In fact this was an easy question. Nevertheless, I wanted to see if the conservative treatment is still alive. In six weeks the fractures healed on a simple sling immobilization. Thank you for your adequate participation. Regards.
Totally conservative, in Mexico we use a universal shoulder immobilizer, and I particularly do not like to use a velpau-type bandage because it is uncomfortable for the patient and does not allow proper axillary hygiene. Greetings.
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