Detaillierte Beitrags-Information

Zurück zur Liste

Beitragstitel Galeazzi-equivalent fracture dislocation in 11-year-old boy - do not miss the ulnar physeal fracture!
Beitragscode P52
Autoren
  1. Patrik Cervenak Vortragender
  2. Birte Schultz Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006 Bern
  3. Stefan Dierauer Orthopädie Sonnenhof
  4. Benjamin Kraler Universitäts-Kinderspital beider Basel (UKBB) Vortragender
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 1 | Kinder
Abstract Introduction
Galeazzi-equivalent fracture dislocations are rare injuries and unique to the pediatric population. The distal radial metaphyseal fracture is associated with disruption of the distal ulnar physis. In contrast to the adult Galeazzi fracture where the distal radioulnar joint (DRUJ) is dislocated and the triangular fibrocartilage complex (TFCC) is injured, the DRUJ and TFCC can remain intact in pediatric cases. Instead, the deforming force dislocates the distal ulnar growth plate. While the distal radial fracture component is immediately evident the disruption of the distal ulnar physis can easily be missed and awareness of this kind of injury is important to prevent malreduction of the ulna.

Case presentation
An 11-year-old male fell on the extended right dominant wrist while playing soccer. Neurovascular status was intact. Radiographs showed a dislocated, apex volar metaphyseal distal radius fracture with disruption of the distal ulnar physis (Salter-Harris type I). Closed reduction of the radius could not be achieved and open reduction of the radius was performed. The pronator quadratus muscle was interposed between the fracture fragments prohibiting reduction. The distal ulnar epiphysis reduced itself once the radius was reduced. Fixation of the radial fracture was achieved by a volar locking plate. To protect the distal ulnar epiphysis from secondary dislocation a long arm cast was applied for 6 weeks. At 6 months follow-up, the patient was pain-free and wrist motion was equal to the other side. No instability of the DRUJ was evident. Grip-strength was 22kg (non dominant left side 22kg). Patient-reported outcome was measured with PROMIS pediatric upper extremity score and was 30/30 points at 6 months. Hard wear removal was performed at 6 months.

Conclusion
Galeazzi-equivalent fracture dislocations can be treated by closed reduction or open reduction if the fractures can not be reduced in a closed fashion. Extensor carpi ulnaris tendon, periosteal flaps or pronator quadratus muscle can inhibit closed reduction.
Premature physeal closure of the distal ulna is a feared complication leading to excessive ulnar minus variance, incongruency of the DRUJ and ulnar translation of the carpus. Ulnar lengthening has been described in cases of premature physeal arrest. To identify growth disturbence of the distal ulna, follow-up is necessary until skeletal maturity and if in doubt wrist x-rays should be compared to the uninjured side.