April 2022: Above and Below

​Wait! What happened there? I had just taken signout, and my colleague was shutting down the x-rays on her computer. This image flashed across the screen.​My passion for orthopedic radiographs took over. Fractures of both forearm bones are not something I see often in my non-trauma center community shop. These are most likely from motor vehicle crashes or falls from heights.My mind jumped to the rule of the ring. It had already been fulfilled with the two fractures. Still, my eyes were drawn to the joint to look for a dislocation. My mind was sorting through the eponyms—Galeazzi, Monteggia, Essex-Lopresti—when my gaze landed on the ulna overlapping Gilula's first arc. Could this patient have one of those too?Joints should not have overlapping bones. The usual gap (where the fibrocartilage complex sits) between the ulna and the triquetrum no longer existed. This clearly was not a usual both-bone fracture. I wanted to see the lateral for confirmation.​It was a variation of a Galeazzi fracture, a fracture of the radial shaft and a distal radioulnar dislocation. Dislocation is not common in both-bone forearm fractures, but it should be considered at the distal radioulnar joint and the elbow. Both have been reported before. (Am J Orthop [Belle Mead, NJ]. 2013;42[5]:E30; https://bit.ly/3JJBz4o.)Tip to Remember:Always check for joint dislocations (above and below) with both-bone fractures of the forearm.​Published: 4/1/2022 9:20:00 AM
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs