Spinal fracture management US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Spinal fracture management. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Spinal fracture management US Medical PG Question 1: A 74-year-old male is brought to the emergency department 1 hour after he fell from the top of the staircase at home. He reports pain in his neck as well as weakness of his upper extremities. He is alert and immobilized in a cervical collar. He has hypertension treated with hydrochlorothiazide. His pulse is 90/min and regular, respirations are 18/min, and blood pressure is 140/70 mmHg. Examination shows bruising and midline cervical tenderness. Neurologic examination shows diminished strength and sensation to pain and temperature in the upper extremities, particularly in the hands. Upper extremity deep tendon reflexes are absent. Strength, sensation, and reflexes in the lower extremities are intact. Anal sensation and tone are present. Babinski's sign is absent bilaterally. Which of the following is most likely to confirm the cause of this patient's neurologic examination findings?
- A. CT angiography of the neck
- B. MRI of the cervical spine without contrast (Correct Answer)
- C. X-ray of the cervical spine
- D. CT of the cervical spine with contrast
- E. Cervical myelography
Spinal fracture management Explanation: ***MRI of the cervical spine without contrast***
- This patient presents with symptoms consistent with **central cord syndrome**, characterized by greater weakness in the upper extremities than the lower extremities, often following a hyperextension injury in older adults with pre-existing cervical spondylosis. **MRI is the gold standard for visualizing soft tissue injuries**, including spinal cord compression, edema, or hemorrhage, which are typical causes of central cord syndrome.
- Given the primary concern for spinal cord injury and the detailed neurological deficits indicating specific cord involvement, **MRI** offers the best resolution for evaluating the extent of cord damage, disc herniation, ligamentous injury, and pre-existing degenerative changes.
*CT angiography of the neck*
- **CT angiography** primarily evaluates the **vascular structures** of the neck (e.g., carotid and vertebral arteries) for dissection, stenosis, or occlusion.
- While vascular injury could occur in trauma, the patient's neurological findings (disproportionate upper extremity weakness, pain and temperature sensation loss) point more directly to **spinal cord pathology** rather than isolated vascular compromise as the primary cause.
*X-ray of the cervical spine*
- **X-rays** are useful for initial screening of **bony fractures** and significant dislocations but offer limited information about soft tissues, such as the spinal cord, ligaments, or intervertebral discs.
- They cannot adequately visualize the spinal cord damage responsible for the patient's specific neurological deficits, making it insufficient for confirming the cause of central cord syndrome.
*CT of the cervical spine with contrast*
- **CT scans** excel at visualizing **bony structures** and acute fractures, but even with contrast, they provide less detail of the **spinal cord parenchyma** and soft tissue ligaments compared to MRI.
- **Contrast** is typically used to highlight vascular structures, inflammatory processes, or tumors, which are not the primary diagnostic concerns suggested by this patient's acute post-traumatic presentation of central cord syndrome.
*Cervical myelography*
- **Myelography** involves injecting contrast into the subarachnoid space, followed by X-ray or CT imaging, to outline the spinal cord and nerve roots.
- While it can identify **spinal cord compression**, it is an **invasive procedure** with risks (e.g., headache, seizures) and has largely been replaced by the non-invasive and superior soft tissue imaging capabilities of MRI, especially in acute trauma.
Spinal fracture management US Medical PG Question 2: A 69-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 16/min, and blood pressure 155/90 mm Hg. The neurologic examination shows paraparesis. The 8th thoracic vertebra is tender to palpation. An X-ray of the thoracic vertebrae confirms a compression fracture at the same level. The laboratory studies show the following:
Laboratory test
Hemoglobin 9 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 5,000/mm3
Platelet count 240,000/mm3
ESR 85 mm/hour
Serum
Na+ 135 mEq/L
K+ 4.2 mEq/L
Cl− 113 mEq/L
HCO3− 20 mEq/L
Ca+ 11.5 mg/dL
Albumin 4 g/dL
Urea nitrogen 18 mg/dL
Creatinine 1.2 mg/dL
Serum electrophoresis shows a monoclonal protein level of 38 g/L. To reduce the likelihood of fracture recurrence, it is most appropriate to administer which of the following?
- A. Calcitonin
- B. Calcitriol
- C. Pamidronate (Correct Answer)
- D. Fluoride
- E. Testosterone
Spinal fracture management Explanation: ***Pamidronate***
- The patient's presentation with **bone pain**, **hypercalcemia**, **anemia**, **elevated ESR**, **renal insufficiency**, and a **monoclonal protein** in serum electrophoresis is highly suggestive of **multiple myeloma**.
- **Bisphosphonates** like pamidronate are crucial in managing multiple myeloma by inhibiting osteoclast activity, reducing bone resorption, and thereby decreasing the risk of **pathological fractures** and managing **hypercalcemia**.
*Calcitonin*
- **Calcitonin** primarily works to lower serum calcium levels quickly but has a less sustained effect on bone remodeling compared to bisphosphonates.
- While it can be used for acute hypercalcemia, its role in preventing long-term fracture recurrence in multiple myeloma is limited.
*Calcitriol*
- **Calcitriol**, the active form of **vitamin D**, promotes calcium absorption from the gut and bone mineralization.
- Administering calcitriol in a patient with pre-existing hypercalcemia due to multiple myeloma would worsen the condition.
*Fluoride*
- **Fluoride** can increase bone density by affecting hydroxyapatite crystal formation.
- However, high doses of fluoride can lead to **fluorosis** and paradoxically increase bone fragility, making it unsuitable for preventing fractures in multiple myeloma.
*Testosterone*
- **Testosterone** is an anabolic steroid that can improve bone density in individuals with **hypogonadism**.
- It is not indicated for preventing fractures in the context of multiple myeloma, where bone destruction is driven by osteoclast activation due to plasma cell proliferation.
Spinal fracture management US Medical PG Question 3: A 36-year-old man is seen in the emergency department for back pain that has been getting progressively worse over the last 4 days. Upon further questioning, he also notes that he has been having a tingling and burning sensation rising up from his feet to his knees bilaterally. The patient states he is having difficulty urinating and having bowel movements over the last several days. His temperature is 97.4°F (36.3°C), blood pressure is 122/80 mmHg, pulse is 85/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for weak leg flexion bilaterally along with decreased anal sphincter tone. Which of the following is the best next step in management?
- A. Emergency surgery
- B. CT
- C. Pulmonary function tests
- D. Lumbar puncture
- E. MRI (Correct Answer)
Spinal fracture management Explanation: ***MRI***
- The patient's symptoms (back pain, ascending paresthesias, bladder/bowel dysfunction, and decreased anal sphincter tone) are highly suggestive of **cauda equina syndrome**. An **MRI of the spine** is the gold standard for diagnosing this condition, as it can visualize the spinal cord and nerve roots directly.
- Early diagnosis and intervention with MRI are crucial to prevent **permanent neurological deficits** in cauda equina syndrome.
*Emergency surgery*
- While emergency surgery might be the next step *after* diagnosis, it is **not the initial diagnostic step**. The cause of the cauda equina syndrome (e.g., disc herniation, tumor) must first be identified.
- Performing surgery without proper imaging could lead to operating on the wrong level or for the wrong pathology.
*CT*
- A **CT scan** can provide information about bony structures but is generally **inferior to MRI** for visualizing soft tissue structures like the spinal cord, nerve roots, and intervertebral discs, which are critical in cauda equina syndrome.
- It may miss subtle compressions or pathologies of the nerve roots.
*Pulmonary function tests*
- **Pulmonary function tests** are used to assess lung function and are **irrelevant** to the patient's acute neurological symptoms and back pain.
- This test would not provide any diagnostic information for suspected cauda equina syndrome.
*Lumbar puncture*
- A **lumbar puncture** is primarily used to analyze cerebrospinal fluid for conditions like infection or inflammation (e.g., meningitis, Guillain-Barré syndrome).
- While Guillain-Barré can cause ascending paralysis, the prominent back pain, bowel/bladder dysfunction, and decreased anal sphincter tone make **cauda equina syndrome** a more likely diagnosis, for which LP is not the primary diagnostic tool.
Spinal fracture management US Medical PG Question 4: A 35-year-old man who suffered a motor vehicle accident 3 months ago presents to the office for a neurological evaluation. He has no significant past medical history and takes no current medications. He has a family history of coronary artery disease in his father and Alzheimer’s disease in his mother. On physical examination, his blood pressure is 110/60 mm Hg, the pulse is 85/min, the temperature is 37.0°C (98.6°F), and the respiratory rate is 20/min. Neurological examination is suggestive of a lesion in the anterior spinal artery that affects the anterior two-thirds of the spinal cord, which is later confirmed with angiography. Which of the following exam findings would have suggested this diagnosis?
- A. Loss of vibratory sense below the level of the lesion
- B. Loss of pain and temperature sensation above the level of the lesion
- C. Negative plantar extensor response in his lower limbs
- D. Flaccid paralysis on the right side
- E. Preserved pressure sensation (Correct Answer)
Spinal fracture management Explanation: ***Preserved pressure sensation***
- **Anterior spinal artery** occlusion affects the **spinothalamic tracts** (pain and temperature) and **corticospinal tracts** (motor function), but spares the **dorsal columns**.
- The **dorsal columns** carry **vibration, proprioception, and discriminative (fine) touch and pressure sensation**, which would therefore be preserved.
- While crude touch/pressure via the anterior spinothalamic tract may be impaired, the preservation of dorsal column function allows for intact discriminative pressure sensation, distinguishing this from other cord syndromes.
*Loss of vibratory sense below the level of the lesion*
- **Vibratory sense** is carried by the **dorsal columns**, which are typically spared in **anterior spinal artery syndromes** as they are supplied by the posterior spinal arteries.
- Loss of vibratory sense would suggest involvement of the posterior part of the spinal cord, inconsistent with an anterior spinal artery lesion.
*Loss of pain and temperature sensation above the level of the lesion*
- **Anterior spinal artery syndrome** causes loss of **pain and temperature sensation** *below* the level of the lesion, as the spinothalamic tracts are affected in the anterior cord.
- Sensation *above* the lesion level should be intact, as those pathways have already ascended past the lesion.
*Negative plantar extensor response in his lower limbs*
- A **negative plantar extensor response** (normal plantar reflex) indicates the toes curl downwards, which is the normal response.
- Lesions of the **corticospinal tract**, such as in anterior spinal artery syndrome, typically cause a **positive Babinski sign** (extensor plantar response), where the big toe extends upwards, indicating upper motor neuron damage.
*Flaccid paralysis on the right side*
- **Anterior spinal artery syndrome** causes **bilateral motor deficits** due to involvement of both **corticospinal tracts** in the anterior cord.
- While initial presentation can be **flaccid paralysis** due to spinal shock below the level of the lesion, it is typically **bilateral**, not unilateral, and evolves to **spastic paralysis** over time.
Spinal fracture management US Medical PG Question 5: A 51-year-old woman comes to the physician because of progressively worsening lower back pain. The pain radiates down the right leg to the lateral side of the foot. She has had no trauma, urinary incontinence, or fever. An MRI of the lumbar spine shows disc degeneration and herniation at the level of L5–S1. Which of the following is the most likely finding on physical examination?
- A. Difficulty walking on heels
- B. Exaggerated patellar tendon reflex
- C. Diminished sensation of the anus and genitalia
- D. Diminished sensation of the anterior lateral thigh
- E. Weak Achilles tendon reflex (Correct Answer)
Spinal fracture management Explanation: ***Weak Achilles tendon reflex***
- A herniated disc at **L5-S1** typically compresses the **S1 nerve root**, which is responsible for the **Achilles tendon reflex**.
- **S1 radiculopathy** presents with weakness in plantarflexion, diminished or absent Achilles reflex, and sensory loss in the **lateral foot** (matching the patient's symptoms).
*Difficulty walking on heels*
- Difficulty walking on heels (**dorsiflexion weakness**) is primarily associated with **L4-L5 disc herniation** compressing the **L5 nerve root**.
- This symptom indicates **L5 radiculopathy**, which affects the tibialis anterior muscle, not S1.
*Exaggerated patellar tendon reflex*
- An exaggerated patellar tendon reflex (**hyperreflexia**) indicates an **upper motor neuron lesion** or spinal cord compression above the lumbar region.
- A disc herniation at **L5-S1** causes a **lower motor neuron lesion** with diminished reflexes, not hyperreflexia.
*Diminished sensation of the anus and genitalia*
- This symptom, along with urinary incontinence and saddle anesthesia, is characteristic of **cauda equina syndrome**, a surgical emergency.
- The patient lacks urinary incontinence and the specific unilateral pain pattern points to isolated **S1 radiculopathy**, not cauda equina syndrome.
*Diminished sensation of the anterior lateral thigh*
- Sensory loss in the **anterior lateral thigh** is associated with compression of the **lateral femoral cutaneous nerve** or **L2-L4 nerve roots**.
- This pattern is not consistent with **L5-S1 disc herniation**, which causes sensory changes in the lateral foot and posterior leg.
Spinal fracture management US Medical PG Question 6: A 19-year-old man is rushed to the emergency department 30 minutes after diving head-first into a shallow pool of water from a cliff. He was placed on a spinal board and a rigid cervical collar was applied by the emergency medical technicians. On arrival, he is unconscious and withdraws all extremities to pain. His temperature is 36.7°C (98.1°F), pulse is 70/min, respirations are 8/min, and blood pressure is 102/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. The pupils are equal and react sluggishly to light. There is a 3-cm (1.2-in) laceration over the forehead. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is a step-off palpated over the cervical spine. Which of the following is the most appropriate next step in management?
- A. Rapid sequence intubation (Correct Answer)
- B. CT scan of the spine
- C. X-ray of the cervical spine
- D. MRI of the spine
- E. Rectal tone assessment
Spinal fracture management Explanation: ***Rapid sequence intubation***
- The patient has a **compromised airway** due to very shallow respirations (8/min), indicating impending respiratory failure, which is prioritized in the management of trauma patients.
- Due to the high suspicion of a **cervical spine injury** (diving into a shallow pool, step-off palpable over the cervical spine), **rapid sequence intubation** is the safest way to secure the airway while maintaining **cervical spine immobilization**.
*CT scan of the spine*
- Imaging studies of the spine are important for diagnosis but must be performed **after securing the airway** and stabilizing vital functions.
- While a CT scan is the preferred imaging modality for evaluating bony spinal trauma, it does not address the immediate life-threatening issue of respiratory insufficiency.
*X-ray of the cervical spine*
- X-rays are less sensitive for detecting all types of cervical spine injuries, especially ligamentous damage, compared to CT or MRI.
- As with other imaging, it should be done **after airway management** is secured.
*MRI of the spine*
- MRI is excellent for evaluating **soft tissue structures** like spinal cord, ligaments, and discs, and is generally performed after initial stabilization and CT for bony injury.
- It is not an immediate diagnostic priority when the patient's airway and breathing are acutely compromised.
*Rectal tone assessment*
- This assessment is part of the neurological examination to evaluate for spinal cord injury, specifically involving the **sacral segments**.
- While important for comprehensive neurological assessment, it is not the most appropriate *next step* when the patient has critical airway and breathing compromise.
Spinal fracture management US Medical PG Question 7: A 22-year-old man is rushed to the emergency department after a motor vehicle accident. The patient states that he feels weakness and numbness in both of his legs. He also reports pain in his lower back. His airway, breathing, and circulation is intact, and he is conversational. Neurologic exam is significant for bilateral lower extremity flaccid paralysis and impaired pain and temperature sensation up to T10-T11 with normal vibration sense. A computerized tomography scan of the spine is performed which shows a vertebral burst fracture of the vertebral body at the level of T11. Which of the following findings is most likely present in this patient?
- A. Intact vibration sense
- B. Bowel incontinence (Correct Answer)
- C. Flaccid paralysis at the level of the lesion
- D. Spasticity below the lesion
- E. Impaired proprioception sense
Spinal fracture management Explanation: ***Bowel incontinence***
- The presented symptoms of acute **bilateral lower extremity flaccid paralysis**, **impaired pain and temperature sensation**, and a T11 **vertebral burst fracture** are highly indicative of **anterior cord syndrome**.
- **Anterior cord syndrome** characteristically involves damage to the **anterior two-thirds of the spinal cord**, affecting the **corticospinal tracts** (motor control), **spinothalamic tracts** (pain and temperature sensation), and the **autonomic fibers** that control bladder and bowel function, leading to **bowel and bladder dysfunction**.
*Intact vibration sense*
- The sensation of **vibration** and **proprioception** is carried by the **dorsal columns** (posterior part of the spinal cord), which are typically **spared** in **anterior cord syndrome**.
- Therefore, **intact vibration sense** is an expected finding, but the question asks for the **most likely finding** that represents a significant complication of the syndrome.
*Flaccid paralysis at the level of the lesion*
- While **flaccid paralysis** is present in the lower extremities, it occurs **below the level of the lesion** due to damage to the descending motor tracts (corticospinal tracts).
- Flaccid paralysis *at* the level of the lesion would typically involve damage to the **lower motor neurons** at that specific segment, which is not the primary feature described for a burst fracture causing **anterior cord syndrome**.
*Spasticity below the lesion*
- **Spasticity** typically develops much **later** in spinal cord injuries, after the initial phase of **spinal shock** resolves (usually weeks to months).
- In the acute phase following a significant spinal cord injury, **flaccid paralysis** is the more common finding below the lesion, reflecting spinal shock.
*Impaired proprioception sense*
- Similar to vibration sense, **proprioception** is primarily mediated by the **dorsal columns**, which are generally **spared** in **anterior cord syndrome**.
- Therefore, **proprioception** would likely be **intact**, not impaired, in this specific type of spinal cord injury.
Spinal fracture management US Medical PG Question 8: A 43-year-old man is brought to the emergency department 40 minutes after falling off a 10-foot ladder. He has severe pain and swelling of his right ankle and is unable to walk. He did not lose consciousness after the fall. He has no nausea. He appears uncomfortable. His temperature is 37°C (98.6°F), pulse is 98/min, respirations are 16/min, and blood pressure is 110/80 mm Hg. He is alert and oriented to person, place, and time. Examination shows multiple abrasions over both lower extremities. There is swelling and tenderness of the right ankle; range of motion is limited by pain. The remainder of the examination shows no abnormalities. An x-ray of the ankle shows an extra-articular calcaneal fracture. Intravenous analgesia is administered. Which of the following is the most appropriate next step in the management of this patient?
- A. Short leg splint and orthopedic consultation
- B. Broad-spectrum antibiotic therapy
- C. MRI of the right ankle
- D. Open reduction and internal fixation
- E. X-ray of the spine (Correct Answer)
Spinal fracture management Explanation: ***X-ray of the spine***
- A **high-energy calcaneal fracture** (especially from a fall from height) is often associated with other injuries, particularly to the **spine**, due to axial loading.
- Approximately **10% of calcaneal fractures** are associated with **lumbar spine compression fractures**, making imaging of the spine an essential next step to rule out this potentially serious concomitant injury.
*Short leg splint and orthopedic consultation*
- While a **short leg splint** is appropriate for initial immobilization and pain control of the ankle fracture, and **orthopedic consultation** is necessary, these steps do not address the immediate need to exclude other critical injuries like spinal fractures in high-impact trauma.
- This option represents definitive management of the ankle rather than comprehensive early trauma assessment in a high-risk patient.
*Broad-spectrum antibiotic therapy*
- **Antibiotic therapy** is primarily indicated for **open fractures** to prevent infection, or in cases of significant soft tissue injury with high contamination risk; the provided information describes an extra-articular fracture with abrasions, but not explicitly an open fracture requiring immediate broad-spectrum antibiotics.
- The focus should first be on skeletal integrity elsewhere and definitive fracture management rather than presumptive infection prevention unless an open fracture is confirmed.
*MRI of the right ankle*
- While an **MRI** can provide detailed imaging of soft tissues, ligaments, and cartilage, and may be useful later for surgical planning or to assess subtle injuries, a plain **X-ray has already confirmed a calcaneal fracture**.
- The immediate priority after a high-energy trauma is to rule out other significant, potentially disabling or life-threatening bony injuries, particularly to the spine, rather than further detailed imaging of the already-identified ankle fracture.
*Open reduction and internal fixation*
- **Open reduction and internal fixation (ORIF)** is a surgical procedure for definitive management of certain fractures; however, it is not the **immediate next step** in the emergency department for initial patient assessment following trauma.
- Before surgical intervention, a comprehensive assessment to rule out other injuries (especially spinal fractures) and to thoroughly plan the specific surgical approach is required.
Spinal fracture management US Medical PG Question 9: A 36-year-old man comes to the emergency department 4 hours after a bike accident for severe pain and swelling in his right leg. He has not had a headache, nausea, vomiting, abdominal pain, or blood in his urine. He has a history of gastroesophageal reflux disease and allergic rhinitis. He has smoked one pack of cigarettes daily for 17 years and drinks an average of one alcoholic beverage daily. His medications include levocetirizine and pantoprazole. He is in moderate distress. His temperature is 37°C (98.6°F), pulse is 112/min, and blood pressure is 140/80 mm Hg. Examination shows multiple bruises over both lower extremities and the face. There is swelling surrounding a 2 cm laceration 13 cm below the right knee. The lower two-thirds of the tibia is tender to palpation and the skin is pale and cool to the touch. The anterior tibial, posterior tibial, and dorsalis pedis pulses are weak. Capillary refill time of the right big toe is 4 seconds. Dorsiflexion of his right foot causes severe pain in his calf. Cardiopulmonary examination is normal. An x-ray is ordered, which is shown below. Which of the following is the most appropriate next step in management?
- A. Above knee cast
- B. IVC filter placement
- C. Fasciotomy (Correct Answer)
- D. Low molecular weight heparin
- E. Open reduction and internal fixation
Spinal fracture management Explanation: ***Fasciotomy***
- The patient's symptoms (severe pain, swelling, pain with passive dorsiflexion, weak pulses, pale/cool skin, and prolonged capillary refill) after a traumatic injury are highly suggestive of **acute compartment syndrome**.
- **Fasciotomy** is the definitive treatment for acute compartment syndrome to relieve pressure and prevent irreversible tissue damage.
*Above knee cast*
- While a cast is used for immobilization of fractures, it would worsen **compartment syndrome** by externally compressing an already swollen limb.
- This patient has signs of compartment syndrome which requires urgent surgical decompression, not just immobilization.
*IVC filter placement*
- **IVC filter placement** is indicated for preventing pulmonary embolism in patients with deep vein thrombosis (DVT) who have contraindications to anticoagulation.
- There is no clinical evidence to suggest DVT in this patient, and the primary concern is acute compartment syndrome.
*Low molecular weight heparin*
- **Low molecular weight heparin (LMWH)** is an anticoagulant used for DVT prophylaxis or treatment.
- It is not indicated for the immediate management of acute compartment syndrome and could increase the risk of bleeding in a patient who likely needs urgent surgery.
*Open reduction and internal fixation*
- **Open reduction and internal fixation (ORIF)** is a surgical procedure to stabilize complex fractures, which may be needed later for a tibial fracture if present.
- However, the immediate priority is to address the limb-threatening acute compartment syndrome before performing definitive fracture repair.
Spinal fracture management US Medical PG Question 10: A 17-year-old boy comes to the emergency department following an injury during football practice. He fell and landed on the lateral aspect of his right shoulder. He is holding his right arm supported by his left arm, with his right arm adducted against his side. He is tender to palpation directly over the middle third of his clavicle. Radiographs reveal a non-displaced fracture of the middle third of the clavicle. Which of the following is the most appropriate treatment at this time?
- A. Open reduction and internal fixation with a compression plate
- B. Open reduction and internal fixation with an intramedullary nail
- C. Figure-of-eight splinting (Correct Answer)
- D. Mobilization
- E. Open reduction and internal fixation with lag screws
Spinal fracture management Explanation: ***Figure-of-eight splinting***
- For **undisplaced or minimally displaced midshaft clavicle fractures**, conservative management with a **simple arm sling or figure-of-eight splint** is the preferred initial treatment.
- Both methods provide **adequate immobilization** and support for healing, especially in pediatric and adolescent patients, with excellent functional outcomes.
- Current evidence suggests **simple sling support** is equally effective and often better tolerated than figure-of-eight splinting.
*Open reduction and internal fixation with a compression plate*
- **ORIF with a compression plate** is typically reserved for **displaced or comminuted clavicle fractures** (displacement >2cm, shortening >2cm, or open fractures), or those with associated neurovascular compromise, which are not present in this non-displaced fracture.
- Surgical intervention for non-displaced fractures carries **risks of infection, hardware irritation**, and non-union that often outweigh the benefits when conservative options are effective.
*Open reduction and internal fixation with an intramedullary nail*
- **Intramedullary nailing** is an alternative surgical option for some clavicle fractures but is generally considered for **displaced or comminuted fracture patterns**, and is not indicated for a non-displaced fracture.
- It involves specific technical challenges and is **less commonly used** for routine, non-displaced mid-shaft clavicle fractures, especially when simpler conservative measures suffice.
*Mobilization*
- **Immediate mobilization** without any form of immobilization would **risk further displacement** of the non-displaced fracture and hinder proper bone healing in the acute phase.
- Although early motion is introduced during the healing process, **initial support and immobilization** is crucial for stability and pain control.
*Open reduction and internal fixation with lag screws*
- **Lag screws** are primarily used for **interfragmentary compression** in specific oblique or spiral fracture patterns, which is not the typical mechanism for midshaft clavicle fractures.
- This method is a form of surgical fixation, which is **not indicated for a non-displaced clavicle fracture** given the excellent outcomes (>95% union rate) with conservative care.
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