reduced and stable: splint and early motion 7.Open reduction of the radial shaft fracture and internal fixation with a dynamic compression plate and screws may also reduce the distal radioulnar joint dislocation 7.įollowing intraoperative assessment of the distal radioulnar joint, the reducibility and stability of the joint determines the indicated treatment: Galeazzi fracture-dislocations are unstable requiring surgical intervention, which involves open reduction and internal fixation (ORIF) of the radial fracture, intraoperative assessment of the distal radioulnar joint for reducibility and stability, and subsequent Kirschner wire fixation of the ulna to the radius, triangular fibrocartilage complex (TFCC) exploration and repair, and splinting or immobilisation in supination via an above-elbow cast 7. In addition to stating the presence of the radial fracture and distal radioulnar joint dislocation, a number of features should be sought and commented on: asymmetry of the distal radioulnar joint when compared to the other forearm 6.widening of the distal radioulnar joint on the frontal view 6.radial shortening may occur, and if greater than 10 mm, suggests complete disruption of the interosseous membrane.dislocation of the distal radioulnar joint.commonly at the junction of the middle and distal thirds.However, good quality orthogonal views are needed to identify and characterise displacement correctly. Galeazzi fractures are classified according to the direction of radial displacement:Ī forearm series is usually sufficient for diagnosis and management planning. Typically, Galeazzi fracture-dislocations occur due to a fall on an outstretched hand (FOOSH) and result in dorsal displacement of the radius (type I) if the axial load was applied to the forearm in supination or volar displacement of the radius (type II) if the forearm was in pronation 7. Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.Galeazzi fractures are primarily encountered in children, with a peak incidence at age 9-12 years 3. In adults, it is estimated to account for ~7% of forearm fractures 3.Posterior Interosseous Neuropathy (PIN) - radial nerve branch affects ~10% of Monteggia fractures.Consider open fracture (look for puncture wounds).If splinted and stabilized, can be discharged after consultation with Ortho.Long arm posterior splint with 90 degrees of elbow flexion and the hand in a neutral position.Findings: Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture.Assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center.Radial head can dislocate anterior, posterior, or laterally.proximal 1/3 Ulna fracture + radial head dislocation (due to ulna shortening).CT scan: Fractures involving coronoid, olecranon, and radial head.Xray: AP, Lateral of elbow, forearm, wrist.PIN neuropathy most commonly associated (hand deviates radially with wrist extension).Decreased ROM at elbow may indicate dislocation.X-ray of Monteggia fracture of right forearm, showing fracture of ulna and dislocation of radius. ![]()
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