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