![]() ![]() Traditionally, immobilization of the forearm in full supination for between 6 and 8 weeks has been recommended in Galeazzi fracture-dislocations. Both DRUJs were slightly loose, and the patients had mild pain in his right wrist in hyperpronation however, the patient had no pain in his left wrist and returned to normal life as a factory worker. The patient’s forearm motion was restored to almost normal, with pronation and supination of 75° and 85° on the right and 80° and 85° on the left, respectively. At the 13-month follow-up, radiographs showed no subluxation of both ulnar heads (Fig. Nine months after the injury, all hardware of both forearm were removed. Splints were removed at 5 weeks, and passive rotation was permitted. and active rotation of both forearms was started. Acceptable reduction of the distal ulnar head and stability of both DRUJs in pronation were confirmed (Fig. Two weeks after the 2nd operation, CT under gentle passive rotation was reexamined. Immediately, postoperative rehabilitation of the wrist and elbow was started without restriction, and active and active-assisted rotation of the forearm from neutral to full supination were allowed. Both arms were splinted in supination (Fig. The fragment was fixed by tension band wiring fixation, resulting in the anatomical reduction and stabilization of the DRUJ. We observed palmar displacement of the avulsion fragment of the ulnar styloid process by the ulnar collateral ligament and periosteum of the ulna, with the avulsion fragment causing dorsal displacement of the ulnar head. There were no tears in the triangular fibrocartilage complex (TFCC) and no tendon incarceration in the DRUJ. To reduce the dorsally dislocated ulnar head, the right DRUJ was exposed on the ulnar head through a dorsoulnar approach. A manual stressing test under fluoroscopic imaging showed that the left DRUJ was slightly loose, but its congruity was good, and passive forearm rotation was smooth and fully possible, thereby obviating the need for additional internal fixation of the ulnar styloid. Following achievement of stable fixation of the radius with the LCP, the external fixator was removed. Iliac cancellous bone was grafted due to improved fracture healing. The left comminuted radius fracture was fixed with a locking compression plate (LCP), consisting of an extra-long 10-hole 2.4-mm distal radius plate (Synthes) in bridging plate fashion through the anterior approach while maintaining reduction with an external fixator. One week after the primary operation, the patient underwent an additional operation. Computed tomography (CT) performed under passive pronation and supination showed acceptable congruity of the left DRUJ in rotation, along with persistent dorsal subluxation of the right ulnar head (Fig. However, the patient complained of pain in his right wrist, and postoperative radiography of the right side revealed dorsal subluxation of the ulnar head (Fig. Due to the lack of a suitable implant, the left comminuted radius fracture was fixed temporarily with an external fixator, to reduce the dislocated ulnar head. The right simple radius fracture was fixed with a 7-hole 3.5-mm limited contact dynamic compression plate (LC-DCP Synthes, Oberdorf, Switzerland) through an anterior approach. Three hours after the injury, the patient underwent an emergency operation. Closed reduction was performed under sedation, but both fracture-dislocations were irreducible. Radiography revealed bilateral Galeazzi fracture-dislocations with dorsally dislocated ulnar heads and ulnar styloid fractures (Fig. A 24-year-old man was riding a motorcycle and collided with a large truck crossing the street ahead him.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |