Forearm
Fracture Dislocation
Combined
fractures include three special combinations of injury: Galeazzi
fracture-dislocation, Monteggia fracture-dislocation, and the Essex-Lopresti
lesion (Fig. 13). Galeazzi
fracture-dislocation refers to a fracture of the shaft of the radius associated
with dislocation of the distal radioulnar joint. Monteggia fracture-dislocation
refers to fracture of the ulna with dislocation of the radial head. Each
of these fracture-dislocation patterns is best treated with open fracture
reduction and closed treatment of the dislocation. Essex-Lopresti
lesion
refers to longitudinal disruption of the radioulnar interosseous membrane
and proximal migration of the radius associated with fractures involving
the proximal radioulnar joint, the distal radioulnar joint, or both sites.
The most common presentation of Essex-Lopresti is associated with radial
head excision for fracture, resulting in ulnocarpal impingement syndrome.
Treatment is controversial. When diagnosed acutely in the context of an
unreconstructable radial head fracture, Essex-Lopresti justifies use of
a temporary radial head implant. Late surgical options include ulnar shortening
osteotomy or the developing technique of ligament reconstruction with a
tendon graft.
Tendon
and ligament avulsion fractures are discussed in the next sections.
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