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Abstract
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Introduction
Displaced distal metaphyseal ulnar fractures and distal radial buckle fractures are quite common among children but their association has never been reported in literature to our knowledge. Thus, classification and management of this pattern remain challenging especially in young children. A Galeazzi-equivalent injury should be suspected.
Methods
We report the case of a 2-year-old boy who presented the above-mentioned association of forearm fractures with a certain displacement between both bones. We compare our management with actual recommendations trough a literature review. Informed consent was obtained.
Results
Initial clinical assessment of our patient was difficult because of his age and pain. He needed a closed reduction of the ulnar fracture under general anesthesia. Immobilization was maintained for 8 weeks. Clinical and radiological evolution were good. No residual pain, no range of motion limitation and no distal radio-ulnar joint ((DRUJ) instability were observed after a five-month follow-up.
Conclusion
Galeazzi-equivalent injury combines an ulnar epiphyseal avulsion associated with metaphysis displacement and a radial fracture in children. This pattern is infrequent although probably underestimated. The initial clinical assessment of the DRUJ could indeed be complicated in young patients, by pain and swelling. Most of these injuries are treated by closed reduction and immobilization. Reported results in literature are quite good but misdiagnosed lesions or improper treatment could also compromise the DRUJ stability, the wrist and forearm range of motion, and generate chronical pain. We would recommend a low suspicion threshold for DRUJ instability in young children presenting a displaced distal metaphyseal ulnar fracture associated with a distal radial buckle fracture. That suspicion should impact treatment and follow-up.
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