Finally, an Elusive Fracture

"Can you give this lady pain medicine?" the nurse said as she pointed to a room.I didn't even know who she was talking about. I didn't have a patient in that room. But wails emanated from that location, and the nurse was advocating for the patient's relief.As I made my way to the room, the nurse added, "She fell and broke her arm." Unwrapping the EMS splint, I knew she was right. I felt the sickening sensation of bones moving above hands. That doesn't happen often in the forearm, and I wondered what the x-ray would reveal. Both the radius and the ulna were broken and grossly unstable. Three of us were needed to stabilize the arm (holding the elbow at 90 degrees and applying traction at the wrist) and to apply a sugar-tong splint. While waiting for the post-reduction films, I wondered if this was one of those named forearm fractures, though the joint should have been involved for that. This distal radioulnar joint (DRUJ) in this case appeared intact. Would the x-rays bear that out? The post-reduction films made it clear that the DRUJ was involved. The joints were level, and the ulna was shortened from the radiocarpal joint. I had studied this injury three times for the boards, but this was my first Galeazzi fracture patient!Usually, one thinks of a Galeazzi as a distal fractured radius and a dislocated ulna at the DRUJ, but it can be more. The minimum definition is a fractured radius with an injury of the DRUJ. An additional fracture of ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs