Orthopedic pitfalls in the ED: Galeazzi and Monteggia fracture-dislocation. Am J Emerg Med. 2001 19(3):225-8. Treasure Island (FL): StatPearls Publishing 2017 Jun-. Available from: PMID: 29262123 Fracture of the distal radial shaft: mistakes in management. Management of complications of forearm fractures. High (up to 90%) complications rates seen if treated nonoperatively ( Perron 2001, Hughston 1957)Ītesok KI et al.Requires ORIF for acceptable outcome because of loss of stability at DRUJ and pull of forearm muscles causes loss of proper alignment in cast,.If unable to reduce, orthopedic consult in ED.Closed reduction of the radius followed by reduction of the ulna in the DRUJ, with application of long arm splint.Managed conservatively, if non-reducible or unstable may require ORIF.Closed reduction of radius fracture and splinting with long arm splint in supination.Managed with ORIF If unable to reduce radial head, orthopedic consult in ED.Priority is closed reduction of the radial head with attention to anatomic alignment of ulna with application of long arm splint.Usually managed conservatively if successful initial reduction.I: anterior dislocation of the radial head. Inability to reduce radial head: Discuss with orthopedics for prompt consultation in ED vs admission for OR vs transfer to pediatric orthopedic referral center Four types are recognized and are generally based on the principle that the direction in which the apex of the ulnar fracture points is the same direction as the radial head dislocation 1-4.Ensure anatomic alignment of the ulna and place in supinated long arm splint.Priority is closed reduction of radial head, often made difficult by associated plastic/greenstick deformity.If discharging from ED after reduction, all need close follow-up with orthopedics (within 1 week).All cases should be discussed with an orthopedist.Open fractures require immediate orthopedic consultation in the ED.Stage 3B features complete disruption of all components of the medial collateral ligament complex of the elbow. This bundle forms the pivot around which the elbow dislocates posteriorly by way of a posterolateral rotatory mechanism. In stage 3A, the posterior part of the medial collateral ligament and all of the soft tissues around it are disrupted whereas the anterior portion, or bundle, is spared. Stage 3 is subdivided into two components. Stage 2 includes further disruption resulting in an incomplete posterolateral elbow dislocation with X-rays demonstrating the coronoid process 'perched' on the humeral trochlea. The result is a posterolateral rotatory subluxation (of the elbow) that can spontaneously reduce. Stage 1 is characterized by complete disruption of the lateral ulnar collateral ligament complex with partial or complete disruption of the remaining lateral collateral ligament complex. In simple posterior dislocations of the elbow, the mechanism of injury can be thought of as a circle of soft tissue disruption starting from the lateral side and progressing to the medial side in three stages. Our case presents a Galeazzi fracture with an associated elbow dislocation, which has yet to be described in the literature.
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