Mateusz Gładysz FESSH prep

FESSH prep Wrist trauma Limits of radiographic predictors of distal radioulnar joint instability, fracture level in Galeazzi injuries, acute radial head excision in Essex Lopresti injury, effect of delayed diagnosis, irreducible dislocation from extensor carpi ulnaris interposition

Galeazzi and Essex-Lopresti injuries

Last reviewed v1.0

FESSH-084Wrist trauma●●● advanced

Regarding Galeazzi fracture-dislocations and Essex-Lopresti injuries of the forearm:

  1. 1.In a series of 66 radial shaft fractures, published radiographic criteria such as radial shortening of more than 5 mm were only moderately accurate predictors of distal radioulnar joint instability.

  2. 2.In Galeazzi fracture-dislocations, a radial shaft fracture within 7.5 cm of the distal radial articular surface is more often associated with distal radioulnar joint instability after fixation than a more proximal fracture.

  3. 3.In an acute Essex-Lopresti injury, proximal migration of the radius that is absent on the initial radiographs does not develop later, even after radial head excision.

  4. 4.In Schnetzke and colleagues' series, Essex-Lopresti injuries diagnosed late had Disabilities of the Arm, Shoulder and Hand scores similar to those diagnosed on the day of injury.

  5. 5.In Bruckner and colleagues' series of distal radioulnar joint dislocations with forearm fractures, the extensor carpi ulnaris displaced volar to the distal ulna blocked closed reduction in two patients.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-084
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In a series of 66 radial shaft fractures, published radiographic criteria such as radial shortening of more than 5 mm were only moderately accurate predictors of distal radioulnar joint instability.

    True

    Tsismenakis and Tornetta tested published radiographic guidelines, including radial shortening of more than 5 mm and a fracture within 7.5 cm of the wrist, in 66 radial shaft fractures. The guidelines were only moderately accurate and even greater shortening did not predict instability, so the authors advise relying primarily on intraoperative assessment of the joint after radial fixation.

    • Tsismenakis T, Tornetta P. Galeazzi fractures: Is DRUJ instability predicted by current guidelines?. Injury. 2016;47(7):1472-7. PMID 27138839

  2. 2. In Galeazzi fracture-dislocations, a radial shaft fracture within 7.5 cm of the distal radial articular surface is more often associated with distal radioulnar joint instability after fixation than a more proximal fracture.

    True

    Rettig and Raskin fixed 40 Galeazzi injuries: 12 of 22 fractures within 7.5 cm of the mid-articular surface had distal radioulnar joint instability after anatomical reduction, against 1 of 18 more proximal fractures. Korompilias and colleagues found the same gradient in 95 patients, with instability after fixation in 37 of 69 distal-third fractures. The association raises suspicion but does not replace testing the joint after the radius is fixed.

    • Rettig ME, Raskin KB. Galeazzi fracture-dislocation: a new treatment-oriented classification. J Hand Surg Am. 2001;26(2):228-35. PMID 11279568
    • Korompilias AV, Lykissas MG, Kostas-Agnantis IP, Beris AE, Soucacos PN. Distal radioulnar joint instability (Galeazzi type injury) after internal fixation in relation to the radius fracture pattern. J Hand Surg Am. 2011;36(5):847-52. PMID 21435802
    • Tsismenakis T, Tornetta P. Galeazzi fractures: Is DRUJ instability predicted by current guidelines?. Injury. 2016;47(7):1472-7. PMID 27138839

  3. 3. In an acute Essex-Lopresti injury, proximal migration of the radius that is absent on the initial radiographs does not develop later, even after radial head excision.

    False

    Proximal migration of the radius may be absent at first and develop over time, so a recent review advises caution with radial head excision in the acute setting. Acute treatment focuses on restoring radial length and temporarily stabilising the distal radioulnar joint.

    • Sheth M, Mitchell S, Bell B, Wu C. Essex-Lopresti Lesions and Longitudinal Radioulnar Instability: A Narrative Review. JBJS Rev. 2022;10(3). PMID 35263316

  4. 4. In Schnetzke and colleagues' series, Essex-Lopresti injuries diagnosed late had Disabilities of the Arm, Shoulder and Hand scores similar to those diagnosed on the day of injury.

    False

    Schnetzke and colleagues followed 31 patients for a mean of 5.3 years. The 16 diagnosed on the day of injury, treated with temporary Kirschner-wire fixation of the distal radioulnar joint in supination for 6 weeks, had better elbow, wrist and pain scores than the 15 diagnosed late, with a mean Disabilities of the Arm, Shoulder and Hand score of 12.5 versus 45.3, and complications or further surgery occurred in 38% versus 93%. Elbow and wrist range of motion did not differ significantly between the groups.

    • Schnetzke M, Porschke F, Hoppe K, Studier-Fischer S, Gruetzner PA, Guehring T. Outcome of Early and Late Diagnosed Essex-Lopresti Injury. J Bone Joint Surg Am. 2017;99(12):1043-1050. PMID 28632594

  5. 5. In Bruckner and colleagues' series of distal radioulnar joint dislocations with forearm fractures, the extensor carpi ulnaris displaced volar to the distal ulna blocked closed reduction in two patients.

    True

    Bruckner and colleagues found that distal radioulnar joint dislocations accompanying forearm fractures were irreducible more often than earlier series suggested. In two of their 11 patients the extensor carpi ulnaris was displaced volar to the distal ulna and open reduction was needed; a mushy or unobtainable reduction is an indication to explore for entrapped tendon, bone or soft tissue.

    • Bruckner JD, Lichtman DM, Alexander AH. Complex dislocations of the distal radioulnar joint. Recognition and management. Clin Orthop Relat Res. 1992;(275):90-103. PMID 1735239