Abstract
BackgroundThere are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods. Arthroscopy for the distal radioulnar joint of the wrist joint has recently been used for wrist pathology. We aim to describe the surgical procedure involved in arthroscopic reduction of irreducible Galeazzi fracture-dislocation and clinical outcome and review the literature.Case presentationWe present the case of a 26-year-old man, a professional athlete, who sustained Galeazzi fracture-dislocation during a bicycle race. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. Operative treatment was performed using a 30° oblique, 1.9-mm arthroscope. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. The metaphyseal and intra-articular fracture of the radius and the fragment of the ulnar styloid were fixed using a volar locking plate and tension band wiring technique, respectively. A daily injection of parathyroid hormone and low-intensity pulsed ultrasound were used postoperatively. The patient was asymptomatic and returned to the preinjury level of athletic activity 2 months postoperatively, and bone union of the radius and ulna was achieved without distal radioulnar joint instability 15 months postoperatively.ConclusionsLess invasive reduction of the dorsal anatomical structure enabled our patient to return early to sports. We consider arthroscopic reduction to be superior to the open surgical method in terms of evaluating interpositions; additionally, arthroscopic reduction is minimally invasive and does not need immobilization because it does not cause significant damage to the dorsal capsule and subsheath of the extensor carpi ulnaris, which comprise the triangular fibrocartilage complex.
Highlights
There are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods
We present a rare case of an irreducible distal radioulnar joint (DRUJ) due to entrapment of a fragment of the ulnar styloid between the sigmoid notch and ulnar head
After the radius was exposed by the trans-flexor carpi radialis approach and reduced with a bone clamp, we evaluated the reduction of the articular surface of the radius by arthroscopy using 3–4 and 4–5 portals in the radiocarpal joint using a 30° oblique, 1.9-mm arthroscope (Stryker K.K., Tokyo, Japan)
Summary
There are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. We present a rare case of an irreducible distal radioulnar joint (DRUJ) due to entrapment of a fragment of the ulnar styloid between the sigmoid notch and ulnar head. Arthroscopy of the DRUJ was performed using distal and proximal DRUJ portals, and this showed ligamentous tissue, the TFCC, the sigmoid notch, and the cancellous bone, which was supposed to be the base of the ulnar styloid fragment (Fig. 2b). The distal ulna was approached from the ulnar side of the wrist, and the fragment of the ulnar styloid containing the distal and proximal components of the TFCC was avulsed from the fovea of the ulna and fixed using the tension band wiring (TBW) technique (Fig. 3)
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