Challenge of the Week / Trauma / 08.20.2021

A 23-year-old male patient presents following a motor vehicle collision with new-onset chest pain that is worse with arm movement. The preliminary result of his chest radiograph is negative for acute cardiopulmonary injury, but upon interview, the patient’s voice is hoarse, and he reports a choking sensation. Physical examination reveals swelling over the anterior aspect of his chest. Which of the following is the most appropriate treatment option?

    • Urgent swallowing study
    • A compromised airway from the posterior sternoclavicular (SC) dislocation would warrant emergency intervention, and the chest pain in more likely from his SC dislocation.

 

    • Operative in situ pinning
    • The priority is to get the joint reduced, and pinning in situ would delay this.

 

    • Urgent serum troponin level
    • A compromised airway from the posterior sternoclavicular (SC) dislocation would warrant emergency intervention, and his chest pain is more likely from his SC dislocation.

 

    • Emergent closed or open reduction of the dislocated joint
    • The patient has symptoms concerning for a posterior sternoclavicular (SC) joint dislocation after a high-energy collision. The medial aspect of the clavicle is likely pressing against vital organs, including his airway and esophagus, causing a choking sensation and hoarseness, and emergency intervention is indicated.

     

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