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.

Radius and Ulna Trauma

2019 ◽  
pp. 65-67
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Radial Head ◽  
Distal Radioulnar Joint ◽  
Monteggia Fracture ◽  
Radial Head Fractures ◽  
Type Iv ◽  
Ulnar Fracture ◽  
Fracture Dislocations ◽  
Diaphyseal Fractures ◽  
Both Bones ◽  
Essex Lopresti

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.

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.

The Essex–Lopresti Lesion: A Variant with a Bony Distal Radioulnar Joint Injury

2006 ◽  
Vol 31 (2) ◽  
pp. 206-207 ◽  
Author(s):  
J. AUYEUNG ◽  
G. BROOME
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Soft Tissue Injuries ◽  
Distal Radioulnar Joint ◽  
Joint Injury ◽  
Radioulnar Joint ◽  
Membrane Rupture ◽  
Ulnar Head ◽  
Proximal Migration ◽  
Essex Lopresti

The Essex–Lopresti lesion is an unusual injury, consisting of a radial head or neck fracture, distal radioulnar joint (DRUJ) injury and interosseous membrane rupture. To date, all reported Essex–Lopresti lesions have consisted of soft tissue injuries at the DRUJ. We present a case of an Essex–Lopresti lesion with a bony variant, in which the DRUJ injury consisted of an ulnar head fracture associated with radial head fracture and acute proximal migration of the radius. The management involved plating of the ulnar head fracture and titanium replacement of the radial head.

scholarly journals Terrible triad of the elbow with an ipsilateral Essex-Lopresti injury: case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Zakaria Ramzi ◽  
Jordi Juanos Cabans ◽  
Harold Jennart
Keyword(s):  
Elbow Dislocation ◽  
Detailed Examination ◽  
Distal Radioulnar Joint ◽  
Interosseous Membrane ◽  
Terrible Triad ◽  
Adequate Treatment ◽  
Radioulnar Joint ◽  
Membrane Rupture ◽  
High Index Of Suspicion ◽  
Essex Lopresti

Abstract Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. The case was managed with closed reduction of the elbow dislocation and distal radioulnar joint followed by open reduction and repair of the damaged structures in the elbow and an unloading of the interosseous membrane. A high index of suspicion with a detailed examination of the elbow, forearm and wrist associated to a comprehensive imaging were mandatory for a complete diagnosis and an adequate treatment. Six months after the accident, the patient made a good recovery.

scholarly journals Nonoperative Treatment of Ulnar Carpometacarpal Fracture–Dislocations

2019 ◽  
Vol 09 (02) ◽  
pp. 160-163
Author(s):  
Isidro Jiménez ◽  
Juan Sánchez-Hernández ◽  
Dimosthenis Kiimetoglou
Keyword(s):  
Closed Reduction ◽  
Case Reports ◽  
Nonoperative Treatment ◽  
Fracture Dislocation ◽  
Joint Stability ◽  
Joint Dislocations ◽  
Secondary Dislocation ◽  
Fracture Dislocations ◽  
Cmc Joint

Abstract Background Ulnar carpometacarpal (CMC) joint dislocations and fracture–dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. Case Description This is a series of eight ulnar CMC joint dislocations and fracture–dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery. Literature Review There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results. Clinical Relevance Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.

Evolution of the Ring Concept for the Forearm and Its Implication on Treatment: From Galeazzi, Monteggia, Essex-Lopresti, and Darrach to the Current Era

2019 ◽  
Vol 24 (03) ◽  
pp. 251-257 ◽  
Author(s):  
Kate Elzinga ◽  
Kevin Chung
Keyword(s):  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Interosseous Membrane ◽  
Annular Ligament ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage ◽  
Essex Lopresti ◽  
Forearm Injuries

Geometrically, rings distribute their stress along their arc instead of concentrating at any one point. The forearm ring is composed of the radius, ulna, proximal radioulnar joint, and distal radioulnar joint. The annular ligament, interosseous membrane, and triangular fibrocartilage complex link and stabilize the ring. Injuries to the forearm occur along a continuum with recognized patterns of ring disruption, including Galeazzi, Monteggia, and Essex-Lopresti injuries. The Darrach procedure causes a disruption to the forearm ring and can lead to painful convergence between the radius and distal ulnar stump. Injuries to the forearm ring are unstable. Management of forearm injuries is centered on the restoration of the anatomy and stability of the forearm ring. Forearm ring injuries and their treatment are discussed in this article.

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.

Irreducible Galeazzi Fracture-Dislocation Due to an Avulsion Fracture of the Fovea of the Ulna

1999 ◽  
Vol 24 (3) ◽  
pp. 379-381 ◽  
Author(s):  
Y. KIKUCHI ◽  
T. NAKAMURA
Keyword(s):  
Open Reduction ◽  
Rare Case ◽  
Avulsion Fracture ◽  
Styloid Process ◽  
Distal Radioulnar Joint ◽  
Fracture Dislocation ◽  
Ulnar Styloid ◽  
Radioulnar Joint ◽  
Galeazzi Fracture ◽  
Ulnar Styloid Process

We report a rare case of Galeazzi fracture-dislocation with an irreducible distal radioulnar joint. The cause of the irreducibility was entrapment of a fragment avulsed from the fovea of the ulna. The patient was successfully treated with open reduction and internal fixation of the radius, ulnar styloid process and avulsed fracture at the fovea of the ulna.

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