6 There are only a handful of reports having Monteggia and Galeazzi fracture-dislocation in the same patient and few reports of Monteggia and distal radius fractures. 5 Four radiological criteria of distal radioulnar joint disruption (DRUJ) have been identified, which includes a fracture of the basal ulnar styloid on an anteroposterior X-ray widening of the DRUJ on a lateral view, dislocation of the radius relative to the ulna and finally, a shortening of the radius of > 5 mm. Galeazzi fracture is also a rare unstable injury of the forearm compromising 3–4% of cases. 4 The complexity of this combination can explain the confusion in classification and treatment. Nevertheless, Monteggia and its variants are associated with a combination of ulnar fracture, radiohumeral dislocation, ulnohumeral dislocation, proximal radioulnar dislocation, radial fracture and distal radioulnar joint/interosseous membrane lesion. 3 A lesion like ours with segmental ulna has not been previously described, and this is because of the peculiar mechanism of injury in our case. However, certain variants or equivalents have also been described in relation to the fracture pattern of ulnar bone. The fracture pattern in adults have a transverse/butterfly ulnar fracture associated with radial head dislocation and universally identified using the Bado classification. 1,2 The mechanism of injury is always a fall on an outstretched hand with a pronated position. Monteggia fracture-dislocation is a rare injury seen in adult and children comprising 1–2% of forearm injuries. Double blow injury (Monteggia and distal radius fracture pattern). At six weeks, physiotherapy with range of movement was started and the patient was moved back to his original place and lost to follow-up.įigure 2: Postoperative X-ray showing fixation of radius and ulna with reduced radial head.ĭ. The sutures were removed at two weeks and recovery was uneventful. Postoperatively, the forearm was immobilized in an above elbow slab in 100 degrees of flexion. In the same sitting internal fixation with a contoured plate of ulna, reduction of radial head, and closed fixation of the distal radius fracture was done using square nails. Under general anesthesia, using the dorsal approach, the wound was thoroughly debrided. There was an associated distal radius fracture ipsilaterally. Radiographs of his right arm and forearm with shoulder, elbow, and wrist joints revealed a segmental fracture of the proximal ulna at the upper part along with anterior radial head dislocation. There was no distal neurovascular deficit. There was diffuse tenderness, swelling tenderness, and bony crepitus felt. On examination, he had a compound fracture with a small bleeding wound (2 × 1.5 cm) over the postero-medial upper part of the forearm and a part of broken bone protruding through it. When the opposite occurs (that is, the radius breaks and shortens), the distal radio-ulnar joint dislocates, resulting in the Galeazzi or "reverse Monteggia" fracture.A 42-year-old migratory laborer presented to the emergency department with an alleged history of being hit by a bull on his right forearm and a subsequent fall. When the ulna is fractured and shortened, the proximal radio-ulnar joint dislocates (the Monteggia fracture). The proximal and distal joints must be carefully scrutinized in every fracture of the forearm. In fractures of the forearm, any shortening of one bone of the forearm necessitates either a fracture of the other with equivalent shortening, or a dislocation at the proximal or distal radio-ulnar joint (Fig 1). Mistakes in their management account for a high incidence of poor results. They are inherently unstable due to a variety of factors which are poorly understood by many surgeons. FRACTURE-dislocations of the forearm are not common injuries.
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