Abstract
BackgroundMonteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture–dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture–dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts.MethodsA comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture–dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture–dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures].ResultsEighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture–dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture–dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors’ knowledge, allowed us to include all types of dislocation and fracture–dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture–dislocations) of the forearm joint.ConclusionsAll injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture–dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment.Level of evidenceV.
Highlights
Over the last two decades, anatomical and biomechanical knowledge of the forearm has greatly improved, and some traumatic injuries involving this anatomical segment can be seen from a new perspective.The concept of forearm joints as described by Dumontier and Soubeyrand is a cornerstone of the full understanding of forearm injuries [1, 2]
A total of 884 articles were identified in PubMed and by bibliographic research (135 Galeazzi, 322 Monteggia, 150 Essex-Lopresti, 187 radial head dislocation, 72 ulnar head dislocation, 1 proximal radioulnar joint (PRUJ) dislocation, and 17 distal radioulnar joint (DRUJ) dislocation)
It is clear that a classification based on Through a systematic review of the literature, we detected rare patterns of two-locker injuries sometimes referred to by incorrect terms of variant or equivalent types of Monteggia and Galeazzi injuries
Summary
Over the last two decades, anatomical and biomechanical knowledge of the forearm has greatly improved, and some traumatic injuries involving this anatomical segment can be seen from a new perspective.The concept of forearm joints as described by Dumontier and Soubeyrand is a cornerstone of the full understanding of forearm injuries [1, 2]. – Two bones: radius and ulna – The interosseous membrane (IOM) – One functional joint: the middle radioulnar joint (MRUJ), formed by the forearm bones and IOM – Two anatomical joints: the proximal radioulnar joint (PRUJ) and distal radioulnar joint (DRUJ). The forearm joint has two anatomical lockers (PRUJ and DRUJ) and one functional locker (MRUJ), allowing stability during pronation and supination of the forearm. The structure of the IOM includes five ligaments: central band, accessory band, distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord [3]. The remaining structures of the IOM (distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord) are not anatomically constant. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts
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