Recognition of subluxation or dislocation of the DRUJ is paramount. The mechanism of injury is a fall on an outstretched pronated hand. It has been previously termed the “fracture of necessity” in reference to the frequent need for surgical intervention. Named after Italian surgeon Ricardo Galeazzi, the Galeazzi fracture-dislocation is a fracture of the middle to distal third of the radius associated with dislocation or disruption of the distal radioulnar joint (DRUJ) (Fig. Galeazzi fracture-dislocation (Piedmont fracture/reverse Monteggia) Debate still exists on whether Holstein-Lewis fractures should be managed conservatively versus early open reduction internal fixation with radial nerve exploration as traumatic injury to the radial nerve has been shown to heal spontaneously. Recognizing this fracture pattern should alert the provider to the possibility of radial nerve injury and prompt a more extensive neurologic assessment. Lateral and AP radiographs are typically sufficient for imaging diagnosis. The Holstein-Lewis fracture thus has an association with radial nerve palsy (22 %). At this particular level, the radial nerve courses distally through the lateral intermuscular septum and is in direct contact with the adjacent bone, leaving the nerve susceptible to injury. ![]() ![]() The injury is a spiral fracture of the distal third of the humerus, typically as a consequence of blunt trauma, with the distal fragment displaced such that the proximal aspect is deviated radially. The Holstein-Lewis fracture was first described by American orthopedic surgeons Arthur Holstein and Gwilym Lewis. Surgical techniques to address recurrent anterior instability include labral repair or bone reconstruction if the degree of bone loss is severe. ![]() These lesions can be diagnosed with a CT (especially 3-D reconstructions) or MRI. Similar to Hill-Sachs, this lesion may result in anterior shoulder joint instability and recurrent dislocations. Any concern for this injury warrants non-emergent magnetic resonance imaging (MRI), which provides evaluation for labral as well as osseous injury. The inferior glenoid rim should be closely interrogated on pre- and post-reduction shoulder radiographs. An osseous or bony Bankart fracture is a chip fracture of the anterior inferior glenoid cortical rim on which the labrum rests (Fig. The soft tissue Bankart lesion is an injury to the anterior or anteroinferior glenoid labrum, the fibrocartilagenous structure that surrounds and deepens the bony glenoid. Named after the renowned English orthopedic surgeon Arthur Bankart, the Bankart lesion is often associated with the Hill-Sachs lesion due to their common mechanism of injury.
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