11/8/2023 0 Comments Galeazzi fracture 2017 pubmed![]() An examination should begin with a visual inspection of the skin and soft tissue paying close attention to visible bony deformities, skin lacerations, muscle contusions, tendon damage and neurovascular deficits. Patients with diaphyseal forearm fractures typically complain of pain at the site of injury. They found stability to be dependent on the distance of the radial fracture from the distal radial articular surface: The second classification system is based on Rettig ME and Raskin KB who categorized Galeazzi fractures based on fracture stability. The first classifications were based on the position of the distal radius: Two classification systems have been proposed when categorizing Galeazzi fractures. Distally the radius connects with the lunate and scaphoid bones of the wrist. The proximal radial head articulates with the capitellum of the humerus (radiocapitellar joint), rotating within the annular ligament during pronation and supination. Distally the ulnar head serves as an insertion point for the TFCC, supplementing the DRUJ. Proximally the ulna consists of the olecranon and coronoid. The radiocapitellar joint largely stabilizes the proximal forearm while the TFCC predominantly supports the distal forearm. The interosseous membrane is responsible for dispersing axial load force to the forearm, 60% to the radiocapitellar joint and 40% to the ulnohumeral joint. The radius and ulna are stabilized by three groups of ligamentous structures: distally the triangular fibrocartilage complex (TFCC), the interosseous membrane, and proximally the annular ligament. Clinics in Orthopedic Surgery, Vol 7, No 4, December 2015.The osseous forearm is composed of the radius and ulna bones. Carpometacarpal Joint Fracture Dislocation of second to fifth finger. International journal of surgery case reports, Vol 22, March 2016. Locked volar distal radioulnar joint dislocation. Arch Orthop Trauma Surg, Vol 120, No 10 October 2000. Isolated palmar dislocation of the distal radioulnar joint in a football player. Subtle radiographic signs of hamate body fracture: a diagnosis not to miss in the emergency department. Perilunate Dislocations and Fracture Dislocations. Advanced Emergency Nursing Journal, Vol 38, No 1, January-March 2016. Image Diagnosis: Scapholunate Dissociation. American Family Physician, Vol 72, No 9, November 2005. A Clinical Approach to Diagnosing Wrist Pain. The Journal of Hand Surgery Am, Vol 26, No 5, September 2001. The frequency and epidemiology of hand and forearm fractures in the United States. Journal of Orthopaedic Surgery and Research, Vol 11, No 99, September 2016. Sports-related wrist and hand injuries: a review. Treatment: Place in a volar splint and arrange close follow-up if a fracture is identified.Pearl: Some argue that CT is indicated in the emergency department for high pretest probability and non-diagnostic x-rays.Diagnostic Imaging: If there is a high pretest probability of hamate’s hook fracture or if the patient reports an ulnar nerve neuropathy, also obtain “ carpal tunnel view.”.Fracture/dislocation can lead to paresthesias or sensory changes in the ulnar nerve distribution. Pearl: The hamate forms part of Guyon’s canal.Symptoms: Patients may report tenderness to palpation at hypothenar eminence (Figure 7) and pain with clenched fist.Can occur with carpometacarpal dislocation at the 4th or 5th digit. Due to clenched fist striking object (punching, driving wheel hitting hand in motor vehicle accident). Epidemiology: Hamate fractures account for 1.7% of wrist injuries and are commonly missed, resulting in non-union, arthritis, and chronic pain.Treatment: If a high index of suspicion for dissociation exists, place the patient in a thumb spica or “Cock up” wrist splint even if films are negative.If a high index of suspicion for dissociation exists, obtain bilateral “clenched fist” views. Diagnostic Imaging: PA x-ray: A positive test is a painful “click” or “pop”. “Watson’s Test” or scaphoid shift test: Palpate the scaphoid tuberosity on the palmar aspect of the affected wrist while moving wrist from ulnar to radial deviation.Pain is worse with an extended and loaded position (a push-up position). Physical Exam: Expect pain just distal to Lister’s Tubercle or at the anatomical snuffbox (Figure 2).Patient may describe a “click” at the wrist. Symptoms: Patient will report dorsal or radial side pain and swelling the pain is often worse when the patient is in a “push up” position.Mechanism: This injury typically occurs after FOOSH or wrist hyperextension.High risk of scapholunate advanced collapse (SLAC) wrist leading to arthritis. Epidemiology: Most commonly missed ligamentous injury of wrist.
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