Talk
I can see a fracture of proximal ulna with lateral dislocation of radius. I will ensure that it is a closed, isolated injury and the limb is neurovascularly intact. I would like to see the lateral view and the full length X-ray of the radius and ulna.
This fracture is known by the eponym Monteggia fracture dislocation and is inherently unstable. Keeping this in mind, I will attempt a closed reduction under sedation from A& E to reduce edema and risk of neurovascular compromise.
I will arrange for an emergency table next day morning trauma list planning for open reduction and internal fixation of ulna. Radial head usually gets reduced by itself
If not, causes are
- Malreduced ulna
- Annular ligament incarceration
- Large radial head fracture
I can see a lateral view of left wrist with forearm showing displaced fracture of lower third of radius with inferior RUJD. I would like to see the lateral view and full length view of radius. This fracture is known by the eponym Galeazzi fracture dislocation, and is known to be inherently unstable.
I will ensure that the injury is closed isolated and limb is neurovascularly intact. I will attempt a closed reduction in the A & E under sedation daily to prevent edema and NV injury and immobilise in a back slab.
I will arrange for an emergency table next day morning trauma list for ORIF of radius
I will check for stability of DRUJ preoperatively
Causes of non reduction are
- Malreduction radius
- ECU interposition
- Extensive soft tissue injury
If unstable, fix with 2 2mm wire from radius to ulna with FA in supination, removed at 4 weeks and start mobilisation
I can see an AP view of wrist showing radial styloid fracture. I would to like to see the lateral view to rule out any associated carpal subluxation due to volar capsule and ligament injury.
I will ensure that the injury is isolated closed and the limb is NV intact, especially for median nerve.
I will do a closed reduction of the fracture under sedation from A&E and check for the post reduction NV status and immobilise in BE moulded dorsal slab.
I will offer an EUA to check for stability and if unstable, I will offer a ORIF. If still unstable I will apply a spanning Ex Fix and arrange for a specialist input