Both Bone Forearm Fracture with Complex DRUJ Dislocation: What Are the Odds?

2021 ◽  
Author(s):  
Vineet Dabas ◽  
Nishant Bhatia ◽  
Gaurang Agrawal
Keyword(s):  
Clinical Presentation ◽  
Forearm Fracture ◽  
Distal Radioulnar Joint ◽  
Fracture Dislocation ◽  
Dorsal Approach ◽  
Pattern Of Injury ◽  
Unusual Association ◽  
Isolated Injury ◽  
Essex Lopresti

Abstract Background Distal radioulnar joint (DRUJ) dislocation can occur as an isolated injury or in association with fracture radius (Galeazzi fracture-dislocation), Essex–Lopresti lesion or, rarely, with fracture of both radius and ulna (termed “Galeazzi type fracture”). DRUJ dislocations can be simple or complex. While simple DRUJ dislocation can be reduced by closed methods once the associated fractures are fixed anatomically, complex dislocation does not reduce by closed means. A complex DRUJ dislocation occurring in a both bone forearm fracture is an extremely unusual pattern of injury. Case Description We describe the clinical presentation, intraop findings, management, and follow-up of two such cases of both bone forearm fracture with complex DRUJ dislocation. In both the cases, the ulnar head was found to be buttonholed through extensor retinaculum between the extensor tendons. Open reduction had to be done via dorsal approach. Timely intervention allowed good results in both the patients. Literature Review Several authors have reported simple DRUJ dislocations in both bone forearm fractures; however, we could come across only three cases of complex DRUJ dislocation in a both bone forearm fracture. A summary of various series and reports on these injuries is presented. Case Relevance Through this case report, we want to highlight this unusual association and emphasize on sequence of fixation, so that this perilous injury pattern is not missed, and favorable outcomes could be obtained through appropriate and timely intervention.

scholarly journals Fracture–dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefano Artiaco ◽  
Federico Fusini ◽  
Arman Sard ◽  
Elisa Dutto ◽  
Alessandro Massè ◽  
...  
Keyword(s):  
Classification System ◽  
Forearm Fracture ◽  
Distal Radioulnar Joint ◽  
Fracture Dislocation ◽  
Radial Head Fractures ◽  
Radioulnar Joint ◽  
Membrane Rupture ◽  
Joint Dislocations ◽  
Fracture Dislocations ◽  
Essex Lopresti

Abstract Background Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture–dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture–dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts. Methods A comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture–dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture–dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures]. Results Eighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture–dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture–dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors’ knowledge, allowed us to include all types of dislocation and fracture–dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture–dislocations) of the forearm joint. Conclusions All injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture–dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment. Level of evidence V.

TRAUMATIC VOLAR DISLOCATION OF THE DISTAL ULNA WITH A FRACTURE OF THE ULNAR STYLOID

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 383-386 ◽  
Author(s):  
Motoki Sonohata ◽  
Hiroko Mine ◽  
Toshiyuki Tsuruta ◽  
Masaaki Mawatari
Keyword(s):  
Functional Disability ◽  
Case Reports ◽  
Forearm Fracture ◽  
Distal Radioulnar Joint ◽  
Emergency Medical Technicians ◽  
Ulnar Styloid ◽  
Distal Ulna ◽  
Ulnar Styloid Fracture ◽  
Type Of Injury

Isolated volar dislocation of the distal ulna without forearm fracture is very rare; however, this injury is incorrectly diagnosed in approximately 50% of cases. This injury can lead to a significant functional disability if left untreated. This report presents a case of isolated volar dislocation of the distal ulna with an ulnar styloid fracture. The dislocation was subsequently reduced, the styloid was surgically repaired, and the patient was satisfied at the last follow-up. The importance of a proper clinical examination and an accurate radiographic position of the wrist are stressed. Furthermore, clinical evaluation of the distal radioular joint after reduction is important in achieving good results. There are various strategies for the treatment of distal radioulnar joint after reduction, including conservative treatment or surgical treatment. We believe that surgical exploration could have been carried out at an earlier stage had such a lesion been suspected. Additional case reports of other instances of successful treatment are needed to educate orthopaedic surgeons and emergency medical technicians on the nature of this type of injury.

scholarly journals Open Galeazzi's Fracture-Dislocation in a 13-Year-Old Boy: A Case Report

2020 ◽  
Author(s):  
Valentino Coppa ◽  
Filippo M. Senes
Keyword(s):  
Case Report ◽  
Complete Recovery ◽  
Distal Radioulnar Joint ◽  
Fracture Dislocation ◽  
Case Description ◽  
Radial Fracture ◽  
Radioulnar Joint ◽  
Complex Injury ◽  
And Function

Abstract Background Galeazzi's fracture-dislocation (GFD) is a rare and complex injury consisting of a radial fracture associated with distal radioulnar joint (DRUJ) dislocation. Case Description We are presenting a case of a boy, who at the onset showed an open GFD and his assessment after a 1-year follow-up. As a treatment, closed reduction and long-arm cast were performed. At the last follow-up, the patient presented a complete recovery of range of motion and function of the affected wrist. Literature Review To the best of our knowledge, in the current literature, there are no reported cases of open GFD. Clinical Relevance Although open GFD is rare this case report may suggest orthopaedic surgeon how to approach and manage it.

Acute Essex-Lopresti Syndrome: About a Case of Brachioradialis Tendon Transfer

2021 ◽  
Author(s):  
Charlotte Gabriel ◽  
Sophie Honecker ◽  
Fred Xavier ◽  
Sybille Facca ◽  
Priscille Lazarus ◽  
...  
Keyword(s):  
Literature Review ◽  
Tendon Transfer ◽  
Single Case ◽  
Distal Radioulnar Joint ◽  
Bone Tunnel ◽  
Case Description ◽  
Percutaneous Pinning ◽  
Radioulnar Joint ◽  
Essex Lopresti

Abstract Background The classic treatment for acute Essex-Lopresti syndrome is closed reduction percutaneous pinning (CRPP) of the distal radioulnar joint (DRUJ). This work aimed to verify whether it was possible to add a transfer of the brachioradialis tendon to the pinning. Case Description The patient was a 39-year-old right-handed man, climbing instructor, who sustained the Mason II fracture and disjunction of the DRUJ. A transfer of the brachioradialis tendon severed from its muscle attach that was made through a bone tunnel passing through the radius and the neck of the ulna. The clinical and radiological result at the 6-month follow-up was satisfactory. Literature Review and Clinical Relevance Our results in a single case showed that the brachioradialis tendon transfer was useful in acute Essex-Lopresti syndrome.

scholarly journals An Unusual Variant of a Floating Forearm Injury: A Case Report and Review

Hand ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. NP32-NP38
Author(s):  
Benjamin F. Plucknette ◽  
Peter C. Rhee
Keyword(s):  
Forearm Fracture ◽  
Elbow Dislocation ◽  
Injury Pattern ◽  
Fracture Dislocation ◽  
Rare Injury ◽  
Irrigation And Debridement ◽  
Unusual Variant ◽  
Perilunate Fracture Dislocation ◽  
Previous Occupation

Background: “Floating forearm” injuries, perilunate injuries, with an elbow dislocation, are rare and challenging to treat. Methods: We present the case of an unusual variant of a floating forearm injury, trans-scaphoid perilunate fracture dislocation and elbow dislocation, with a concomitant open both-bone forearm fracture after a fall from a ladder. Treatment involved irrigation and debridement of the forearm wound, open reduction and internal fixation of the forearm and perilunate injury, and closed reduction of the elbow. Results: At final follow-up, he had returned to his previous occupation. Radiographs demonstrated fully healing fractures without evidence of osteonecrosis or degeneration. Conclusions: A review of the presentation, evaluation, and management of this rare injury pattern is provided.

Corrective osteotomy in forearm fracture malunion improves functional outcome in adults

2010 ◽  
Vol 36 (2) ◽  
pp. 102-106 ◽  
Author(s):  
D. S. Y. Chia ◽  
Y. J. Lim ◽  
W. Y. C. Chew
Keyword(s):  
Functional Impairment ◽  
Joint Instability ◽  
Forearm Fracture ◽  
Corrective Osteotomy ◽  
Distal Radioulnar Joint ◽  
Forearm Fractures ◽  
Forearm Rotation ◽  
Radioulnar Joint ◽  
Initial Injury

Malunions of forearm fractures in adults can present with limitation of forearm rotation, or as distal radioulnar joint instability with functional impairment. This contrasts with paediatric patients in whom malunions of similar severities are often better tolerated. We did a retrospective review of six adult patients after corrective forearm osteotomy for symptomatic malunited forearm shaft fractures. The corrective operations were done between 7 and 168 months after initial injury, using oblique or wedge osteotomies. Median follow-up was 22.5 months. The patients recovered well, with statistically significant improvement in forearm rotation and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. No significant complications occurred.

X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture

2020 ◽  
Author(s):  
Henrik Johan Sjølander ◽  
Sune Jauffred ◽  
Michael Brix ◽  
Per H. Gundtoft
Keyword(s):  
Diagnostic Imaging ◽  
Forearm Fracture ◽  
Minimal Risk ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Distal Forearm Fracture ◽  
Standard Regimen ◽  
Prolonged Immobilization ◽  
Distal Forearm Fractures

Abstract Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

Desmoid tumour of the distal forearm involving the distal radioulnar joint

2020 ◽  
Vol 13 (11) ◽  
pp. e237097
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Avijeet Prasad ◽  
Manoj Bhagirathi Mallikarjunaswamy
Keyword(s):  
Distal Radioulnar Joint ◽  
Treatment Modalities ◽  
Desmoid Tumour ◽  
X Rays ◽  
Distal Forearm ◽  
Left Wrist ◽  
Radioulnar Joint ◽  
Magnetic Resonance Imaging Mri ◽  
Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

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