【原】骨科英文书籍精读（115）｜盖氏骨折

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GALEAZZI FRACTURE-DISLOCATION OF THE RADIUS

Mechanism of injury

This injury was first described in 1934 by Galeazzi. The usual cause is a fall on the hand; probably with a superimposed rotation force. The radius fractures in its lower third and the inferior radio-ulnar joint subluxates or dislocates.

Clinical features

The Galeazzi fracture is much more common than the Monteggia. Prominence or tenderness over the lower end of the ulna is the striking feature. It may be possible to demonstrate the instability of the radio-ulnar joint by ‘ballotting’ the distal end of the ulna (the ‘piano-key sign’) or by rotating the wrist. It is important also to test for an ulnar nerve lesion, which may occur.

X-ray 

A transverse or short oblique fracture is seen in the lower third of the radius, with angulation or overlap. The distal radio-ulnar joint is subluxated or dislocated.

Treatment

As with the Monteggia fracture, the important step is to restore the length of the fractured bone. In children, closed reduction is often successful; in adults, reduction is best achieved by open operation and

compression plating of the radius. An x-ray is taken to ensure that the distal radio-ulnar joint is reduced. 

There are three possibilities:

1.  The distal radio-ulnar joint is reduced and stable.

   No further action is needed. The arm is rested for a few days, then gentle active movements are encouraged. The radio-ulnar joint should be checked, both clinically and radiologically, during the next 6 weeks.

2.  The distal radio-ulnar joint is reduced but unstable .

   The forearm should be immobilized in the position of stability (usually supination), supplemented if required by a transverse K-wire.The forearm is splinted in an above-elbow cast for 6 weeks. If there is a large ulnar styloid fragment, it should be reduced and fixed.

3.  The distal radio-ulnar joint is irreducible.

   This is unusual. Open reduction is needed to remove the interposed soft tissues. The triangular fibrocartilage complex (TFCC) and dorsal capsule are then carefully repaired and the forearm immobilized in the position of stability (again, usually supination, supported by a wire if needed) for 6 weeks.

---from 《Apley’s System of Orthopaedics and Fractures》

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重点词汇整理：

superimposed/,sʊpərɪm'poz/adj. [地物] 叠加的；上叠的；重迭的；叠覆的，重叠的

inferior /ɪnˈfɪriər/n. 下级；次品adj. 差的；自卑的；下级的，下等的

Prominence or tenderness over the lower end of the ulna is the striking feature.尺骨下端突出或压痛是其显著特征。

Prominence /ˈprɑːmɪnəns/n. 突出；显著；突出物；卓越

 striking feature显著特征

subluxated or dislocated.半脱位或脱位

supination/,sju:pi'neiʃən/n. 旋后；反掌姿势

styloid /ˈstaɪˌlɔɪd/n. 茎突adj. 茎突的；茎状的；尖长的；针状的；笔形

 The triangular fibrocartilage complex 三角形纤维软骨复合体

dorsal capsule背部关节囊

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百度翻译：

桡骨GALEAZZI骨折脱位

损伤机制

这种损伤最早是在1934年由Galeazzi描述的。通常的原因是手上摔了一跤；可能是由于旋转力的叠加。桡骨下三分之一及下桡尺关节骨折脱位或脱位。

临床特征

Galeazzi骨折比Monteggia骨折更常见。尺骨下端突出或压痛是其显著特征。通过“抽签”尺骨远端（“钢琴键符号”）或旋转手腕，可能有助于显示桡尺关节的不稳定性。对可能发生的尺神经损伤进行检测也很重要。

X射线

桡骨下三分之一处可见横形或短斜形骨折，有成角或重叠。桡尺关节远端半脱位或脱位。

治疗

与孟氏骨折一样，重要的一步是恢复骨折的长度。对于儿童，闭合复位通常是成功的；对于成人，复位最好通过开放手术和

半径的压缩电镀。为了确保远端桡尺关节复位，需要进行x光检查。

有三种可能性：

1桡尺骨远端关节复位稳定，无需进一步手术。手臂休息几天，然后鼓励轻柔的活动。在接下来的6周内，应进行尺桡关节的临床和放射学检查。

2桡尺骨远端关节减少但不稳定前臂应固定在稳定的位置（通常为旋后位），如果需要横向K形位，则予以补充-电线。那个前臂用夹板固定在肘部上方，持续6周。如果尺骨茎突有较大的碎片，应予以复位固定。

3。桡尺骨远端关节不能复位这是不寻常的。需要切开复位以去除插入的软组织。然后仔细修复三角纤维软骨复合体（TFCC）和背囊，并将前臂固定在稳定位置（同样，通常是旋后位，必要时用钢丝支撑）6周。

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