On-line version ISSN 2309-8309
SA orthop. j. vol.13 n.4 Pretoria Dec. 2014
S MaqungoI; W NkomoII
IMBChB(Natal), FCOrtho(SA), MMed(UCT); Consultant, Orthopaedic Trauma Surgeon
IIMBChB(UCT), Medical Officer, Orthopaedic Trauma Service, Groote Schuur Hospital, University of Cape Town, Cape Town
We present a previously undescribed lesion of a fractured proximal radius associated with a proximal radio-ulnar joint dislocation. Compression plating was performed via the Thompson approach and closed reduction of the proximal radio-ulnar joint (PRUJ) was attained. At one-year follow-up he had united fully and regained full use of his arm. Clinicians need to be aware of this possible variation when confronted with proximal radius fracture.
Key words: Galeazzi fracture, proximal radio-ulnar joint dislocation, Monteggia fracture
Displaced diaphyseal forearm fractures in adults associated with dislocation of either the proximal or distal radio-ulnar joints are inherently unstable, and plate fixation plus joint reduction of these injuries is the current gold standard. These injury combinations are respectively known by their eponymous names: Monteggia and Galeazzi fractures1-3
We present a unique case of a fractured proximal radius with associated proximal radio-ulnar joint dislocation. To our knowledge this injury pattern has not been described before.
Ethics approval was obtained from our institution and the patient consented to the study.
We treated a 21-year-old male patient who was involved in a motor vehicle accident as a driver. He sustained blunt chest trauma with rib fractures but no head or intraabdominal injuries. His right forearm was neurovascularly intact and he had no open wounds. He had no tenderness over the distal radio-ulnar joint so an Essex-Lopresti lesion was excluded.4
Radiographs (Figures 1a and 1b) revealed a displaced transverse fracture in the proximal third of the right radius with an associated posterior dislocation of the right proximal radio-ulnar joint (PRUJ).
Compression plating via the Thompson approach was performed and closed reduction of the PRUJ was attained; this was stable throughout the forearm and elbow range of movement arc.5 The elbow joint was stable with no apparent ligament injury.
At one-year follow-up he had united fully and had a full range of movement of the forearm and elbow (Figures 2a and 2b). The calcification noted at the proximal aspect of the forearm may represent localised injury to the interosseous membrane but this patient did not have an Essex-Lopresti injury clinically.
Compression plating via the Thompson approach was performed and closed reduction of the PRUJ was attained
At one-year follow-up he had united fully and had a full range of movement of the forearm and elbow
Missed PRUJ dislocations may result in disabling complications such as limited forearm and elbow range of movement, chronic pain and chronic PRUJ instability. A vigilant eye for dislocation of both the proximal and distal radio-ulnar joints dislocation should be maintained when dealing with displaced diaphyseal radius fractures.
1. Sebastin SJ, Chung KC. A historical report on Riccardo Galeazzi and the management of Galeazzi fractures. J Hand Surg Am 2010;35(11):1870-77. [ Links ]
2. Bado JL. The Monteggia lesion. Clin Orthop 1967;50:71-76. [ Links ]
3. Boyd HB, Boals JC. The Monteggia lesion: A review of 159 cases. Clin Orthop 1969;66:94-100. [ Links ]
4. Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br. 1951 May;33B(2):244-37. [ Links ]
5. Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57A:287-97. [ Links ]
Dr S Maqungo
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