galeazzi Fracture

Fifty-five adults who had a fracture of both bones of the forearm were managed with plating and were followed for a mean of six years (range, one year to sixteen years and two months) with functional and radiographic assessment. Malunion was quantified by measurement of the amount and location of the maximum radial bow in relation to the contralateral, normal forearm. Fifty-four of the radial and fifty-four of the ulnar fractures united. Eighty-four per cent of the patients had an excellent, good, or acceptable functional result, according to the criteria of Grace and Eversmann. Bone-grafting did not affect the rate of union. Restoration of the normal radial bow was related to the functional outcome. A good functional result (more than 80 per cent of normal rotation of the forearm) was associated with restoration of the normal amount and location of the radial bow (p less than 0.05 and p less than 0.005). Similarly, the recovery of grip strength was associated with restoration of the location of the radial bow toward normal (p less than 0.005).

Forearm fractures are common injuries in childhood. There are a number of important principles that should be followed to achieve the ideal goal of fracture healing without deformity or dysfunction. I will review the general principles, classifications, diagnosis, treatment, and complications of pediatric forearm fractures, including some specific injuries such as Monteggia fractures, Galeazzi injuries, and open fractures. The basic principle is to accurately align the fracture fragments and to maintain this position until the fracture is united. Forearm fractures in children can be treated differently from adult fractures because of continuing growth in both bones (radius and ulna) after the fracture has healed. As long as the physes are open, remodeling can occur. However, generally it is thought that rotational deformity does not remodel. Undisplaced fractures may be treated in a cast until the fracture site is no longer painful. Most displaced fractures of the forearm are best maintained in a long arm cast. However, redisplacement occurs in 7 to 13% of cases, usually within 2 weeks of injury. Unstable metaphyseal fractures should be percutaneously pinned. Unstable diaphyseal fractures can be stabilized by intramedullary fixation of the radius and ulna. If none of these techniques is helpful, plate and screw fixation is the best choice.

Forty-nine Monteggia and forty-seven Galeazzi lesions were treated over a twenty-five-year period. I used Bado's criteria to evaluate the results in the Monteggia lesions. In all of the children in the series either closed or open reduction yielded good results, while the results of treatment of the Monteggia fractures in the adults in the study varied. The best results were obtained in Type-I lesions treated by open anatomical reduction, internal stabilization of the ulnar fracture, and closed reduction of the radial head. Factors leading to poor results in Type-I lesions were failure to obtain anatomical reduction of the ulna, heterotopic ossification including synostosis of the proximal parts of the radius and ulna, and persistence or recurrence of dislocation of the radial head. In patients in whom the radial head could not be reduced by closed methods, the radial head was buttonholed through the joint capsule and the annular ligament was displaced but not ruptured. I have not found that reconstruction of the annular ligament is necessary in the treatment of acute Monteggia fractures. In the Type-II, III, and IV lesions in this series, fair results were the rule. The results of closed reduction of the classic Galeazzi fractures in the adults in this series were not good, due to malunion of the radius and persistent derangement of the distal radio-ulnar joint. The seventeen patients who were treated with accurate reduction and internal fixation of the fractured radius and immobilization of the forearm in full supination for six to eight weeks obtained good results.