2. Pt is 31yom who presents
after a bar room
altercation, in which he
was hit directly on the
forearm with a pool cue. Pt
is complaining of diffuse
left forearm pain and
swelling, as well as left
wrist pain. Pt’s arm is held
at side with elbow flexed,
and pt denies any other
injuries.
T 98.4 P 94 BP 140/85 O2
99%
MSK- diffuse soft tissue
swelling over dorsal aspect
of left forearm, no obvious
deformity or lacerations.
TTP over mid-forearm up
to wrist, with increased
pain at wrist with
flexion/extension
Neuro- 5/5 strength
throughout, normal
sensation, 2+ distal pulses
3.
4. Mid-shaft radial fx (red arrow) with disruption of DURJ (distal
ulnar/radial joint) [ blue arrow] Note the prominence of the distal ulna.
5. Pain control
Urgent Ortho consult, as ORIF of radius needed, as
well as open visualization of RU joint.
Temporary reduction of radius recommended while
awaiting surgical consultation
Compartment syndrome precautions
6. “Fracture of necessity" -adult Galeazzi fracture is not
amenable to treatment by closed means, necessitating
surgical stabilization.
Pediatric Galeazzi fx usually treated with closed reduction
and casting
Fx is almost always located just above proximal border of
pronator quadratus
Weight of hand tends to cause subluxation of distal RU
joint & dorsal angulation of the fx radius
Brachioradialis causes shortening & rotation of distal RU
joint
Mechanism usually FOOSH (specifically, a fall that causes
an axial load to be placed on a hyperpronated forearm) or
direct blow to forearm
