| Author | Affiliation |
|---|---|
| Shinsuke Takeda, MD | Anjo Kosei Hospital, Emergency and Critical Care Center, Anjo, Japan; Nagoya University Graduate School of Medicine, Department of Hand Surgery, Nagoya, Japan |
| Katsuyuki Iwatsuki, MD, PhD | Nagoya University Graduate School of Medicine, Department of Hand Surgery, Nagoya, Japan |
| Akihiko Tabuchi, MD | Anjo Kosei Hospital, Emergency and Critical Care Center, Anjo, Japan |
| Sadahiro Kubo, MD | Anjo Kosei Hospital, Emergency and Critical Care Center, Anjo, Japan |
| Satoshi Teranishi, MD | Anjo Kosei Hospital, Emergency and Critical Care Center, Anjo, Japan |
| Hitoshi Hirata, MD, PhD | Nagoya University Graduate School of Medicine, Department of Hand Surgery, Nagoya, Japan |
CASE PRESENTATION
An 11-year-old boy fell onto his outstretched arm. He presented to the emergency department with a deformity of his left wrist. Radiograph revealed a greenstick fracture with volar angulation of the distal radius. The distal ulnar physis was disrupted (Salter-Harris type II) and the proximal metaphyseal fragment was displaced dorsally; however, the distal radioulnar joint was intact (Image 1). Closed reduction of the distal ulna under axillary block failed. Three-dimensional computed tomography (3DCT) was performed before open reduction.
DIAGNOSIS
This type of fracture is known as a Galeazzi-equivalent fracture. Galeazzi-fracture dislocation is a well-known injury, consisting of a distal radial shaft fracture and dislocation of the distal radioulnar joint (DRUJ). It is rare in adults, and even more uncommon in children. In contrast, Galeazzi-equivalent fractures consist of a fracture at the distal radial metadiaphyseal area with complete distal ulnar epiphyseal separation instead of the more common pattern of DRUJ dislocation.1 The ulnar physeal fracture in a Galeazzi-equivalent injury can be irreducible due to soft tissue interposition (periosteum, extensor tendons, or joint capsule). It is important to identify and analyze these fractures precisely, as growth arrest has been reported after such injuries.2 3DCT revealed the interposition of the extensor carpi ulnaris between the fragments, which hindered the reduction; this was confirmed intraoperatively (Image 2). The patient required open reduction and fixation of the ulnar physeal fracture with two Kirschner wires. He has regained wrist range of motion, with no complications at two-year follow-up.
CPC-EM Capsule
What do we already know about this clinical entity?
The ulnar physeal fracture in a Galeazzi-equivalent fracture can be irreducible due to soft tissue interposition, such as periosteum, extensor tendons, or joint capsule.
What is the major impact of the image(s)?
The interposition of the extensor carpi ulnaris (ECU) between the fragments, which hindered the reduction was revealed by three-dimensional computed tomography (3DCT).
How might this improve emergency medicine practice?
This case report reveals the ECU interposition of this Galeazzi-equivalent fracture by 3DCT and shows the difficulty of closed reduction in the emergency department.
Documented patient informed consent and/or Institutional Review Board approval has been obtained and filed for publication of this case report.
Footnotes
Section Editor: Manish Amin, DO
Full text available through open access at http://escholarship.org/uc/uciem_cpcem
Address for Correspondence: Katsuyuki Iwatsuki, MD, PhD, Nagoya University Graduate School of Medicine, Department of Hand Surgery, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi 466-0065, Japan. Email: kiwatsuki@med.nagoya-u.ac.jp. 2:363 – 364
Submission history: Revision received May 9, 2018; Submitted June 24, 2018; Accepted July 5, 2018
Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
REFERENCES
1. Galanopoulos I, Fogg Q, Ashwood N, et al. A widely displaced Galeazzi-equivalent lesion with median nerve compromise. BMJ Case Rep. 2012.
2. Suthar A, Kothari A. Galeazzi-equivalent pronation type Injury with splitting of ulnar epiphyseal plate into two fragments – A rare case report and review of literature. J Orthop Case Rep. 2014;4(4):25-28.