From the Guidelines
To order a CT scan for a clavicular fracture, first determine if it's clinically necessary, as plain radiographs are typically sufficient for most clavicle fractures, but CT scans are generally indicated for complex fractures, suspected intra-articular involvement, or when surgical planning is needed, as recommended by the American Academy of Orthopaedic Surgeons 1. When considering a CT scan, the following steps should be taken:
- Contact the hospital's radiology department through the electronic medical record system or by phone to place the order.
- Provide patient information, including name, date of birth, and medical record number.
- Specify the clinical indication, such as "clavicular fracture with suspected intra-articular involvement" or "complex fracture requiring surgical planning".
- Include relevant clinical history, including mechanism of injury and findings on physical examination.
- Specify "CT scan of the clavicle without contrast" and indicate urgency if applicable.
- Consider any special considerations, such as patient positioning limitations due to pain. The use of CT scans in these cases is supported by the American College of Radiology, which recommends CT for delineation of fracture planes in traumatic shoulder pain 1. However, the most recent guideline from the American Academy of Orthopaedic Surgeons 1 should be prioritized, as it provides the most up-to-date recommendations for the treatment of clavicle fractures.
From the Research
Ordering a CT Scan for a Clavicular Fracture
To order a CT scan for a clavicular fracture, it is essential to understand the evaluation and management principles of clavicle fractures.
- The initial evaluation typically begins with a thorough history and physical examination, followed by plain radiographs to identify the fracture site and pattern 2.
- However, there is no direct evidence in the provided studies that suggests the use of CT scans as the primary imaging modality for clavicular fractures.
- CT scans are more commonly associated with vascular imaging 3, rather than the initial evaluation of clavicle fractures.
- The classification of clavicle fractures, such as the Allman classification, is typically used to determine the strategy for management, including the potential need for open reduction and internal fixation 2, 4, 5.
- It is crucial to note that the provided studies focus on the evaluation, classification, and management of clavicle fractures, rather than the specific use of CT scans for diagnosis.
- If a CT scan is deemed necessary, it is likely to be used in conjunction with other imaging modalities, such as plain radiographs, to provide a more comprehensive understanding of the fracture and guide treatment decisions.