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ABSTRACT: INTRODUCTION: Galeazzi fracture associated with ipsilateral posterior elbow dislocation and radial head fracture is a rare pattern of injury. Few reports exist that describes this injury pattern and its treatment. We describe a case report of simultaneous occurrence of Galeazzi fracture and ipsilateral dislocation of elbow. PRESENTATION OF CASE: A 58 year-old female presented with Galeazzi fracture and posterior elbow dislocation associated with radial head fracture of left upper extremity. This was managed with closed reduction of the elbow, open reduction and internal fixation of the radial shaft fracture and K-wire stabilisation of the unstable distal radioulnar joint. Prophylactic fasciotomy was performed. At 10 months follow-up, the outcome was favourable with the American shoulder and elbow surgeon score of 92 and the disabilities of the arm, shoulder and hand score of 18. DISCUSSION: The presumed mechanism of the injury was a forceful axial loading of a hyperpronated forearm and extended elbow. Our literature review shows that this pattern of injury occurs as a result of high energy trauma in young individuals, and successful outcome can be achieved by addressing each component of this complex injury individually. CONCLUSION: Simultaneous occurrence of elbow dislocation and Galeazzi fracture seems to be the result of extreme axial force and unique position of upper extremity at the time of impact. Individualised approach to each component of this injury can result in favourable outcome.
International journal of surgery case reports. 05/2013;
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ABSTRACT: Supracondylar humeral fractures in children are common presentations to the ED but might be challenging to both diagnose and assess clinically. The ED has a critical role in accurately assessing the child, the limb's neurovascular status and initiating treatment. A specific approach to the clinical assessment of such a child is required as failure to detect neurovascular compromise can delay appropriate treatment and result in serious consequences. Most children can be investigated with X-ray radiograph alone with further treatment directed by severity of the fracture, commonly described using the Gartland classification. Our review article provides an overview of supracondylar humeral fractures and a suggested clinical approach to leave the emergency physician better equipped to assess and manage these fractures.
Emergency medicine Australasia: EMA 10/2010; 22(5):418-26. · 0.98 Impact Factor
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ABSTRACT: Closed reductions of distal radial fractures are among the most common orthopaedic operations but up to 39% of fractures lose position postoperatively. This study was carried out to determine the most significant risk factors for loss of position so that high-risk patients can be identified early and their management tailored accordingly.
We retrospectively reviewed 48 consecutive children who had redisplacement of their distal radial fractures after closed reduction and compared them with 48 matched controls. Fourteen risk factors were studied and analyzed with univariate and multivariate logistic regression analysis and receiver operating characteristics analysis. These risk factors included pre-reduction and post-reduction fracture characteristics as well as 4 previously described radiological indices of plaster quality.
Significant independent clinical risk factors identified were the initial radial fracture displacement [odds ratio (OR) 1.03, P = 0.001] and obliquity (OR 0.93, P = 0.006), a completely displaced radial fracture (OR 5.21, P =0.003), an ipsilateral ulnar fracture (OR 3.56, P = 0.003), residual radial displacement (OR 1.06, P = 0.009), angulation (OR 1.16, P = 0.011), and failure to achieve anatomical reduction (OR 0.18, P = 0.004). Significant radiological indices included the Padding index (OR >100, P = 0.004), Canterbury index (OR 99, P = 0.014), and 3-point index (OR 19.29, P < 0.001). Nonsignificant risk factors included the angulation of the initial radial fracture, a completely displaced ulnar fracture, plaster changes/splitting and the Cast index. The combined preoperative presence of a completely displaced radial fracture, an ipsilateral ulnar fracture and failure to achieve perfect reduction was found to be the best predictor of redisplacement (receiver operating characteristic area under the curve=0.82). This combination was found to be a better predictor of redisplacement than any of the radiological indices (receiver operating characteristic area under the curve ≤ 0.74) and it is also a more practical risk factor for the operating surgeon to use.
The combination of a completely displaced distal radial fracture and an ipsilateral ulnar fracture, which then cannot be perfectly reduced, was the best predictor for redisplacement. We recommend that serious consideration be given to primary wire fixation in these patients.
III, prognostic.
Journal of pediatric orthopedics 31(5):501-6. · 1.23 Impact Factor
