Galeazzi Fracture
Fracture of distal radial shaft with distal radial-ulnar joint disruption. Remember “MUGR” to recall where the fracture is located. Here’s a quick summary.
• Fracture of distal radial shaft with distal radial-ulnar
joint (DRUJ) disruption, peak age 9-13
• Radius fracture will be obvious; signs of DRUJ
disruption on x-ray include ulnar styloid fracture,
widened DRUJ (usually 1-2 mm), 25 mm of radial
shortening
• Mechanism: Fall onto outstretched hand
• Exam: swollen forearm and wrist, limited ROM
especially in supination/pronation and at wrist
• Possible associated injuries: Rare
• ED Management: Pain control
• Splint: Posterior long arm with supination
• Ortho consult: Yes
• Disposition
• Children: closed reduction of radius and DRUJ, usually
do not require operative intervention
• Adults: closed reduction of radius and DRUJ, always
followed by ORIF of radius and stabilization of DRUJ
MH/CCF/CWRU EM Res @MetroHealth_EM
#Galeazzi #Fracture #Forearm #Radius #Radial #Distal #Radiology #XRay #Diagnosis #Management #Orthopedics #MSK
Rib fractures on POCUS
1. look for a discontinuity at the site of pain and tenderness
2. US beats CXR on time, cost, accuracy, and radiation. Most CXR are wasted on rib fx
3. Satisfies pt desire for imaging and validation beyond a clinical diagnosis; the biggest reason I do it.
If looking for rib fx w POCUS, orient in line on long axis with the rib course based on chest location. Then rotate to confirm in the short axis plane. Be wary of the bone - cartilage junction...easy to interpret this as a step off / fracture.
- Dr. David Mackenzie @mackendc
Patient can guide you to the site of tenderness. Look for disruption of bony cortex and or associated overlying hematoma. Could be time consuming, and won't completely replace x-ray!
#Rib #fracture #POCUS #clinical #ultrasound #trauma
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RADIAL HEAD FRACTURE
Radial head fractures are the most common elbow fracture in adults and are also the most commonly missed elbow fracture! Here’s a quick summary.
• Most common elbow fracture in adults, also the most commonly missed elbow fracture
• When looking at an elbow x-ray review alignment (anterior & radiocapitellar lines), fat pads (anterior & posterior) and bone cortex
• If a fracture cannot be identified but anterior sail sign or posterior fat pad is seen, treat as non-displaced radial head fracture!
• Mechanism: Fall onto outstretched hand
• Exam: Tenderness to lateral elbow, limited ROM especially in supination/pronation
• Possible associated injuries: Ligamentous injury (LCL > MCL), coronoid or olecranon fracture, distal radioulnar joint injury, interosseous membrane injury, elbow dislocation, scaphoid fracture
• ED Management: Pain control
• Splint: Sling
• Ortho consult: No, if Type l; Yes, if Types II-IV
• Disposition: Type I, DC with ortho follow-up within 1week; Types II-IV, pending orthopedic recommendations
MH/CCF/CWRU EM Res @MetroHealth_EM
#RadialHead #Radius #Fracture #Elbow #Radiology #XRay #Diagnosis #Management #Orthopedics #MSK
Distal Radius Fracture
Distal radius fracture is the most common orthopedic injury. Here's a quick summary.
• Fracture at the metaphysis or articulation of distal radius
• Most common orthopedic injury
• Eponyms:
• Colles (90% "dinner fork") = dorsally displaced. extra-articular
• Smith ("reverse Colles") = volar displaced. extra-articular
• Barton = intra-articular dorsal or volar (more common) rim fracture
• Chauffer = radial styloid fracture
• Mechanism: Fall onto outstretched hand
• Exam: variable gross wrist deformity with decreased ROM
• Possible associated injuries: DRUJ disruption, radial styloid fracture, median nerve injury, acute carpal tunnel syndrome, soft tissue injuries (TFCC injury, scapholunate and/or lunotriquetral ligament injury)
• ED Management: Hematoma block +/- procedural sedation and reduction using finger traps
• Splint: Sugar tong
• Ortho consult:
No if Colles or Chauffer unless unable to reduce;
Yes if Smith or Barton
• Disposition: DC home if Colles or Chauffer with orthopedic follow-up within I week; Smith or Barton, pending orthopedic recommendations
MH/CCF/CWRU EM Res @MetroHealth_EM
#Radius #Fracture #Forearm #Radial #Colles #Distal #Radiology #XRay #Diagnosis #Management #Orthopedics #MSK
