A Widely Displaced Galeazzi Equivalent Lesion with Median Nerve Compromise

Case Report

Austin J Orthopade & Rheumatol. 2018; 5(1): 1063.

A Widely Displaced Galeazzi Equivalent Lesion with Median Nerve Compromise

Athar MS¹*, Galanopoulos1 I¹, Fogg Q² and Ashwood N¹

¹Department of Trauma and Orthopaedics, Queens Hospital, Burton-on-Trent, UK

²Laboratory of Human Anatomy, School of Life Sciences, University of Glasgow, UK

*Corresponding author: M Sajjad Athar, Department of Trauma and Orthopaedics, Queen’s Hospital, Burtonon- Trent, UK

Received: November 28, 2017; Accepted: January 31, 2018; Published: February 08, 2018

Abstract

We present the case of a 14-year-old patient with a right distal radial fracture accompanied by a severely displaced complete distal ulnar physeal separation and associated median nerve compromise. This injury is known as Galeazziequivalent lesion in children and is an extremely rare injury associated with growth arrest. Recognition of the lesion can be difficult but wide displacement may be associated with other significant injuries such as neurovascular compromise.

Prompt intervention reversed the neurological symptoms. At ten months after the operation, neither growth arrest nor loss of range of motion has occurred. A review of the literature identifies a number of important reasons that dictate prompt reduction when there is complete separation of the ulna physis mainly because of soft tissue interposition or capsule problems.

Keywords: Physeal ulna injury; Salter–Harris; Galeazzi-equivalent

Introduction

Physeal fractures account for about 18% of all fractures in children and are usually classified according to the Salter-Harris classification system. The majority of these injuries are type II in Salter–Harris classification. About 3.3% of all physeal injuries involve the distal ulna. In 11–50% of the cases, distal radius fractures are accompanied with fractures of the ulna [1].

Some Salter–Harris type I and II distal ulnar epiphyseal injuries have been reported as needing open reduction [2-5] due to either tendon interposition [3]. or a rupture in the capsule [4].

The Galeazzi fracture-dislocation is a well-known injury including fracture of the distal radial shaft and dislocation of the Distal Radioulnar Joint (DRUJ). It is rare in adults and even more uncommon in children. A variant of the classic injury, the Galeazzi-equivalent fracture, consists of a fracture at the distal radial metadiaphyseal area with complete distal ulnar epiphyseal separation instead of the more common pattern of DRUJ dislocation [6-7].

This is the first case noted to have neurological compromise within the literature requiring urgent treatment.

Case Presentation

A 14-year-old boy presented to the accident and emergency department after a fall on his right outstretched hand whilst playing handball. On examination the right wrist was swollen and deformed, with tenderness over the distal radius and ulna on palpation. The skin was intact and the elbow and proximal forearm were non-tender. There was reduced sensation over the area of the median nerve distribution but with no distal vascular compromise. Antero-posterior and lateral radiographs of the right wrist showed a dorsally displaced and rotated Salter–Harris type I fracture of the distal ulnar epiphysis with a dorsally displaced metaphyseal fracture of the distal radius (Figure 1). These findings suggested the so-called paediatric Galeazzi- equivalent fracture, which is very rare among this population.