galeazzi fracture (1)
TRANSCRIPT
Forearm Case 2
History and PhysicalPt is 31yom who
presents after a bar room altercation, in which he was hit directly on the forearm with a pool cue. Pt is complaining of diffuse left forearm pain and swelling, as well as left wrist pain. Pt’s arm is held at side with elbow flexed, and pt denies any other injuries.
T 98.4 P 94 BP 140/85 O2 99%
MSK- diffuse soft tissue swelling over dorsal aspect of left forearm, no obvious deformity or lacerations. TTP over mid-forearm up to wrist, with increased pain at wrist with flexion/extension
Neuro- 5/5 strength throughout, normal sensation, 2+ distal pulses
Radiographs
Diagnosis: Galeazzi fx/dislocation
Mid-shaft radial fx (red arrow) with disruption of DURJ (distal ulnar/radial joint) [ blue arrow] Note the prominence of the distal ulna.
Pain controlUrgent Ortho consult, as ORIF of radius
needed, as well as open visualization of RU joint.
Temporary reduction of radius recommended while awaiting surgical consultation
Compartment syndrome precautions
ED Management
“Fracture of necessity" -adult Galeazzi fracture is not amenable to treatment by closed means, necessitating surgical stabilization.
Pediatric Galeazzi fx usually treated with closed reduction and casting
Fx is almost always located just above proximal border of pronator quadratus
Weight of hand tends to cause subluxation of distal RU joint & dorsal angulation of the fx radius
Brachioradialis causes shortening & rotation of distal RU joint
Mechanism usually FOOSH (specifically, a fall that causes an axial load to be placed on a hyperpronated forearm) or direct blow to forearm
Pearls
Additional Images
http://www.wheelessonline.com/ortho/galeazzis_fracture_adults_1
http://www.mypacs.net/cases/GALEAZZI-FRACTURE-RADIAL-SHAFT-FX--DISRUPTION-OF-THE-DRUJ-ULNAR-STYLOID-FX-801523.html
http://emedicine.medscape.com/article/1239331-overview
http://www.mskcases.com/index.php?module=article&view=194
http://www.ncbi.nlm.nih.gov/pubmed/8145315
References