Combination of Galeazzi fracture, fracture ulnar head, and ipsilateral posterior elbow dislocation: A rare case report

Mohammad Jesan Khan; Ariz Raza; Ujjawal Singhal; Sidra Asif

doi:10.4103/jbjd.jbjd_3_22

CASE REPORTS

Year : 2022 | Volume : 37 | Issue : 1 | Page : 15-17

Combination of Galeazzi fracture, fracture ulnar head, and ipsilateral posterior elbow dislocation: A rare case report

Mohammad Jesan Khan¹, Ariz Raza¹, Ujjawal Singhal¹, Sidra Asif²
¹ Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India
² Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India

Date of Submission	26-Jan-2022
Date of Acceptance	12-Apr-2022
Date of Web Publication	13-May-2022

Correspondence Address:
Mohammad Jesan Khan
Department of Orthopaedic Surgery, Faculty of Medicine, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, UP
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jbjd.jbjd_3_22

Abstract

Posterior elbow dislocation, ipsilateral Galeazzi fracture, and fracture of ulnar head is a very unusual injury pattern. In the literature, only eight such cases have been reported. Another such case of a 24-year-old woman is being reported by us. Elbow dislocation was reduced immediately under sedation in an emergency. Radius was fixed with a compression plate and distal ulna was fixed with a K wire. Elbow and wrist physiotherapy is started 3 weeks after immobilization.

Keywords: Elbow dislocation, fracture of ulnar head, Galeazzi fracture

How to cite this article:
Khan MJ, Raza A, Singhal U, Asif S. Combination of Galeazzi fracture, fracture ulnar head, and ipsilateral posterior elbow dislocation: A rare case report. J Bone Joint Dis 2022;37:15-7

How to cite this URL:
Khan MJ, Raza A, Singhal U, Asif S. Combination of Galeazzi fracture, fracture ulnar head, and ipsilateral posterior elbow dislocation: A rare case report. J Bone Joint Dis [serial online] 2022 [cited 2022 May 25];37:15-7. Available from: http://www.jbjd.in/text.asp?2022/37/1/15/345164

Introduction

Galeazzi fracture is a radial diaphyseal fracture with distal radioulnar joint (DRUJ) disruption.^[1] It accounts for approximately 7% of all fractures of the forearm.^[2] Elbow is a relatively stable joint even after elbow dislocations are fairly common.^[3] After shoulder dislocation, elbow dislocation is the second most common joint dislocation.^[4] Approximately 90% of the elbow dislocations are posterior or posterolateral dislocations.^[5] Approximately 25% of elbow dislocations are complex and associated with fractures around the elbow.^[6] However, elbow dislocations with ipsilateral Galeazzi fracture and fracture of ulnar head are extremely rare and only eight such cases are reported.^{[7],[8],[9],[10],[11],[12],[13],[14]} We are reporting another case of posterior dislocation of the elbow with an ipsilateral Galeazzi fracture and fracture of ulnar head.

Case Report

A 24-year-old female patient presented to us in the emergency ward after sustaining injury to her left upper limb in a road traffic accident. On examination, there was deformity and tenderness over the forearm, elbow, and wrist. Plain radiograph showed Galeazzi fracture dislocation with ipsilateral posterolateral dislocation and fracture of ulnar head [Figure 1]a, [Figure 2]a

Figure 1: (A) Radiograph showing posterior dislocation of elbow. (B) Radiograph after reduction

Click here to view

Figure 2: (A) Preop radiograph showing fracture of shaft of radius with DRUJ dislocation along with ulnar head fracture. (B) After radius fracture fixator with small fragment DCP and ulnar head fracture fixation with K wire

Click here to view

Elbow dislocation was reduced in the emergency under sedation [Figure 1b] After reduction, the elbow joint was found to be stable. After two days, the patient was operated and open reduction and internal fixation were done with six-hole small fragment dynamic compression plate using a 3.5 mm cortical screw through modified Henry approach. Ulnar head fracture was fixed with a 2.5 mm K wire [Figure 2b]. On the operating table, DRUJ was found to be stable. Three doses of antibiotics prophylaxis during perioperative period as per our institutional protocol.^[15] Above elbow slab was given for 2 weeks after that slab was removed and elbow physiotherapy was started.

Discussion

Forceful axial loading of forearm on extended wrist and hyper-pronated forearm is mechanism of injury in most of the reported Galeazzi fractures.^[1],[2] Posterior elbow dislocation of elbow is mainly caused by a posterior directed force on falling outstretched hand.^[3],[4] Posterior elbow dislocation and ipsilateral Galeazzi fractures are very rare injury pattern and only eight such cases are reported in the literature.^{[7],[8],[9],[10],[11],[12],[13],[14]} Out of which six patients were male and two patients were female. The mean age was 21 years (range 16–58). Road traffic accidents were the most common mode of injury (four patients) suggesting high-velocity trauma causing such injury patterns. In all patients, the radius was fixed with compression plates. In two patients DRUJ was found unstable intraoperatively and fixed with pinning of DRUJ.^[10],[13] The case reported by Ng and Rose where the patient is having posterior elbow dislocation was associated with coronoid fracture for which open reduction and internal fixation of coronoid along with collateral ligament was done.^[10] In the patient reported by Rajeev et al. elbow dislocation was neglected and open reduction and collateral ligaments repair was done.^[12]

Conclusion

Galeazzi fracture associated with ipsilateral posterior elbow dislocation is a rare pattern of injury. Close reduction of the elbow should be done immediately. Radius fracture should be fixed with compression plates. After radius fixation if DRUJ is unstable, it should be fixed with K wire.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.

Ethics approval and consent to participate

Approval for study was taken from Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh ethical committee (institutional).

Availability of data and material

All data generated or analyzed during this study are included in this published article (and its supplementary information files, especially in tables).

References

1.	Atesok KI, Jupiter JB, Weiss AP. Galeazzi fracture. J Am Acad Orthop Surg 2011;19:623-33.
2.	Johnson NP, Smolensky A. Galeazzi fractures. [Updated 2021 Jul 20]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021.
3.	Waymack JR, An J. Posterior elbow dislocation. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021.
4.	Morrey BF, editor. The Elbow and Its Disorders. 2nd ed. Philadelphia, PA: WB Saunders; 1993.
5.	Cohen MS, Hastings H 2nd. Acute elbow dislocation: Evaluation and management. J Am Acad Orthop Surg 1998;6:15-23.
6.	Wyrick JD, Dailey SK, Gunzenhaeuser JM, Casstevens EC. Management of complex elbow dislocations: A mechanistic approach. J Am Acad Orthop Surg 2015;23:297-306.
7.	Mezzadra A, Gusmeroli E, Tettamanzi M, Prestianni B, Molinari D. A rare injury to the upper limb: Elbow dislocation combined with Galeazzi fracture-dislocation. Ital J Orthop Traumatol 1991;17:567-72.
8.	Sarup S, Bryant PA. Ipsilateral humeral shaft and Galeazzi fractures with a posterolateral dislocation of the elbow: A variant of the “floating dislocated elbow”. J Trauma 1997;43:349-52.
9.	Shiboi R, Kobayashi M, Watanabe Y, Matsushita T. Elbow dislocation combined with ipsilateral Galeazzi fracture. J Orthop Sci 2005;10:540-2.
10.	Ng VY, Rose S. Combined elbow fracture-dislocation and Galeazzi fracture in an adult: A case report and review of the literature. Curr Orthop Pract 2010;21:330-3.
11.	Nanno M, Sawaizumi T, Takai S. Case of bilateral Galeazzi fractures associated with dislocation of the right elbow. J Nippon Med Sch 2011;78:384-7.
12.	Rajeev A, Senevirathna S, Harrison J. Subacute dislocation of the elbow following Galeazzi fracture-dislocation of the radius: A case report. J Med Case Rep 2011;5:589.
13.	Asadollahi S, Shepherd D, Hau RC. Elbow fracture-dislocation combined with Galeazzi fracture in adult: A case report and literature review. Int J Surg Case Rep 2013;4:748-52.
14.	Abalo A, Akloa KK, Dellanh YY. Elbow Dislocation with ipsilateral Galeazzi fracture: A case report. Open J Orthop 2016;6:276-82.
15.	Agrawal NK, Khan MJ, Sherwani MKA, Zahid M, Ahmad S, Shukla I. Short-course perioperative: Antibiotic prophylaxis to prevent surgical site infection in elective orthopedic surgery. J Orthop Traumatol Rehabil 2018;10:67.