The ulna loses the protection of the ligament structure and exhibits a floating condition. 4).Īssociation of the Galeazzi fracture with dislocation of the elbow would result in dislocation of the DRUJ and ulnohumeral joint. The range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm (Fig. After 12 months, the patient had no pain or clinical evidence of instability (Fig. After 8 weeks, the K-wire was removed from the DRUJ, and pronation and supination exercises were then commenced. Extension exercises of the elbow joint were started with a limited motion brace. The extremity was immobilized in a long arm plaster slab with the elbow in 90° flexion and the forearm in the neutral position for 4 weeks. Although the dislocation of the distal radioulnar joint (DRUJ) was anatomically reduced after internal fixation, when the forearm was pronated, dorsal dislocation of the ulna was found under fluoroscopic examination and pinned in neutral position using a 2.0-mm Kirchner wire (K-wire) (Fig. A seven-hole 3.5-mm locking compression plate was used to stabilize the radius. After that, the patient underwent an open reduction and internal fixation of the radial fracture using a standard palmar approach of Henry. Under brachial plexus nerve block, reduction of the elbow dislocation was performed immediately, and radiographs confirmed the elbow to be in joint and tested stability. The patient was taken to the operating room three hours after arrival at the emergency department. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1–2 m in high-energy trauma. The “floating ulna” injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. Range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm. At the 12-month follow-up, the patient had no pain or signs of instability. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. Case presentationĪ 33-year-old female at 38 + weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. A few reports have described this type of injury and its treatment. Reduction of all Galeazzi injury patterns is best accomplished with the forearm in full supination in an above-elbow cast.Ipsilateral Galeazzi fracture with elbow dislocation, namely the “floating ulna” injury, is a rare injury pattern. To define the various fracture patterns in an attempt to facilitate diagnosis and management, a classification of the Galeazzi injury complex in children has been devised. Recognition of the Galeazzi-equivalent fracture pattern is sometimes difficult. An analysis of outcome of 10 fractures showed less favorable results in the six Galeazzi-equivalent fractures compared to the four classic Galeazzi injuries, with one child sustaining a complete growth plate arrest of the distal ulna secondary to an equivalent injury. A variant, the "Galeazzi-equivalent fracture" involving a separation of the distal ulnar growth plate with displacement of the ulnar metaphysis was shown to be more common than the "classic" Galeazzi fracture in a 15-year review of this fracture pattern at the Children's Hospital of Eastern Ontario. Fracture of the distal radius with dislocation of the distal ulna, the so-called Galeazzi fracture, is uncommon in children.
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