Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics
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April Radiology 2007 Answer Key

  This patient is an 16 year old male presents to the ED with the chief complaint of right upper chest pain after a fall. The following Ct Scan is shown.

Questions:

1. Describe what you see?

    • Posterior dislocation on the medial right clavicle with asymmetric compression on the trachea

2. What would you see on a plain radiograph?

      Chest x-rays may be normal, even with a dislocation but an anteriorly dislocated clavicular head will appear higher than the normal side whereas a posteriorly dislocated clavicular head will appear lower than the normal side

3. What are the complications? Approximately 25% of posterior SCJ dislocations are associated with tracheal, esophageal, or great vessel injury and may involve the following specific complications:

      • Tracheal rupture or erosion
      • Pneumothorax
      • Laceration of the superior vena cava
      • Occlusion of the subclavian artery and/or vein
      • Recurrent dislocation
      • Decreased range of motion
      • Residual swelling or deformity

4. How who you manage this patient? Reduction of a posterior dislocation frequently requires general anesthesia but closed reduction may fail and require open reduction and internal fixation

    • Consult an orthopedic surgeon for reduction and possible operative stabilization of posterior dislocations.
    • Suspicion of tracheal disruption or mediastinal damage secondary to a posterior dislocation necessitates evaluation by a thoracic surgeon.
    • Pain management

Trivia: The famous Watkins Glen concert, which reportedly eclipsed Woodstock attendance figures, featured the Allman Brothers and which other two bands?

  • Answer: Grateful Dead and The Band.

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