Galeazzi Fractures are a type of fracture of the radial shaft which is associated with dislocation of the distal radio-ulnar joint (DRUJ). This particular fracture is name after Ricardo Galeazzi who was an Italian surgeon in Milan. This injury is uncommon and only accounts for about 7% of all forearm fractures in adults.
A radius fracture may be short, oblique, or transverse and involves a fractures at the junction of the middle third and distal third of the radius with associated injury to the distal-ulnar joint. The closer the fracture is to the DRUJ, the more likely that it will be unstable. Dislocation of the DRUJ is usually dorsal. It may be associated with either a ligamentous injury or fracture of the styloid process of the ulna.
A fracture is usually located above the proximal border of the pronator quadratus muscle. The distal fragment usually moves towards the ulna. Galeazzi fractures are best treated with open reduction and internal fixation of the radius and assessment of the distal radio-ulnar joint.
Surgery is necessary. Nonsurgical treatment in adults usually results in recurrent dislocations of the distal ulna and a bad outcome. Surgery is done by a volar plate fixation. Followed by assessment of the Distal Radio Ulnar Joint (DRUJ), if stable, the forearm will be splinted in supination for six weeks. If the joint is unstable, reduce and pin the distal radio-ulnar joint in supination for about four weeks. If the joint is not reducible, open and explore the joint. Check for entrapment of the ECU.
Avascular necrosis is death of a segment of bone. AVN may affect the proximal humerus due to interruption of the blood supply. The ascending branch of the anterior humeral circumflex artery runs in the lateral bicipital groove and then becomes the arcuate artery. The other artery that is important to the blood supply is the posterior humeral circumflex artery.
There are several risk factors for AVN including: Alcohol, Systemic Lupus Erythematosus, infection, trauma, and steroid use. 5-25% of AVN cases are due to steroid usage. Steroids increase the serum lipids in the blood which may precipitate fat embolism into the humeral head blood vessels.
Progressive collapse of the humeral head occurs due to bone death, reabsorption, remodeling, micro fractures and final collapse with joint changes and arthritis. Symptoms include: shoulder pain, weakness, crepitus, and a decreased range of motion. Symptoms are gradual and insidious with delay in the diagnosis and treatment. The patient usually has a history of risk factors.
In regards to imagining, x-rays will show the best in the neutral rotation AP view. AVN located on the superior middle part of the humeral head just deep to the articular cartilage. If the crescent sign is seen, this is an indicator of collapse. An MRI is going to be the best imaging study. A patient with AVN of the humerus should have a hip radiograph. If the x-ray is negative and the patient has hip pain, you should obtain an MRI of the hip. It is recommended that a patient with osteonecrosis at the site of the shoulder should undergo an MRI of the hip to rule out asymptomatic osteonecrosis of the hip. You may also need to do an x-ray of the knee. AVN may involve three or more anatomic sites (multifocal osteonecrosis).
Treatment typically consists of:
Core decompression for Stage I and Stage II
Resurfacing for Stage III
Hemiarthroplasty for Stage III and Stage IV
Total shoulder surgery for Stage V
The results of total shoulder are inferior to patients with osteoarthritis
The Salter-Harris fracture is a common injury in children, involving the growth plates of the long bones. Approximately 15% to 30% of all childhood fractures are growth plate fractures and are common in the lower leg bones (tibia and fibula). It is important to detect these fractures as they may affect the growth of the bone if not treated properly.
There are five types of Salter-Harris fractures. The higher the type number, the more complications associated with the fracture.
Only 5% of fractures are Type I. It may be difficult to diagnose unless there is obvious displacement and sometimes the diagnosis is a clinical one. Type I fractures occur though the weak zone of the provisional calcification and are known for their fast healing and rare complication rate.
Approximately 75% of fractures are type II. These fractures occur at the physis (growth plate) and metaphysis – and when the corner of the metaphysis separates (Thurston-Holland Sign). The fragment usually stays with the epiphysis while the rest of the metaphysis will displace. Typically, healing is fast and growth is usually okay; however, distal femur fractures may result in growth deformity.
10% of fractures are Type III, which are defined as fractures of the growth plate and epiphysis, or even a split of the epiphysis. The fractures extend into the articular surface of the bone and will require reduction of the joint. In distal femur fractures it may result in a growth deformity.
About 10% of fractures are Type IV fractures—which pass through the epiphysis, physis (growth plate), and the metaphysis. Type IV fractures can cause complications such as growth disturbance and angular deformity.
Type V fractures are uncommon, only occurring about 5% of the time. In type V fractures, compression or a crush injury of the growth plate takes place. This fracture has no association with the epiphysis or metaphysis and an initial diagnosis may be difficult. Despite being uncommon, these fractures have the highest incidence of growth deformity and disturbance.
Extension contracture of the knee can result from different causes, but it usually occurs from trauma. The patient is unable to bend the knee to a functional level.
Trauma will cause adhesions inside the knee, fibrosis, and shortening of the knee ligaments.
There will also be adhesions and shortening of the quadriceps muscles.
Treatment will usually begin with therapy. The first surgical option will include an arthroscopy and the release of any adhesions. The second surgical option that may be considered as a quadricepsplasty (Thompson or Judet) or a combination of treatments.
An example of a combination treatment plan would be a modified Judet quadricepsplasty with the release of the quadriceps muscle from the femur and a release of the adhesions that are located inside the knee.
After surgery the surgeon can usually achieve 90° plus flexion.