High-energy trauma in most cases is another cause of the “floating ulna” injury. According to the accident described in the previous studies (Table 1), falling from a height of 1–2 m was the most likely cause of “floating ulna” injury. The average age of the 7 patients was 34 years old (26–58 years). Of the publications, only 7 cases of “floating ulna” injury were strictly screened out (Table 1), comprising five male and two female patients. The transmitted axial force levers the ulna out of trochlear articulation, causing dislocation of the ulnohumeral joint. Collapse of the radial column would result in transmission of the continuing force through the intact ulna and interosseous membrane of the forearm. The forceful axial loading from the impact with the ground could have caused the dislocation of the DRUJ, resulting in the radius fractures. The mechanism responsible for the “floating ulna” injury in the present case can be considered as due to a transmission of axial forces starting from the outstretched hand combined with extreme pronation of the forearm to full elbow extension. This complex injury can be considered a “floating ulna” injury, which differs from the Essex-Lopresti injury, Criss-Cross injury, floating forearm, and floating radius injury of the forearm. The ulna loses the protection of the ligament structure and exhibits a floating condition. 4).Īssociation of the Galeazzi fracture with dislocation of the elbow would result in dislocation of the DRUJ and ulnohumeral joint. The range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm (Fig. After 12 months, the patient had no pain or clinical evidence of instability (Fig. After 8 weeks, the K-wire was removed from the DRUJ, and pronation and supination exercises were then commenced. Extension exercises of the elbow joint were started with a limited motion brace. The extremity was immobilized in a long arm plaster slab with the elbow in 90° flexion and the forearm in the neutral position for 4 weeks. Although the dislocation of the distal radioulnar joint (DRUJ) was anatomically reduced after internal fixation, when the forearm was pronated, dorsal dislocation of the ulna was found under fluoroscopic examination and pinned in neutral position using a 2.0-mm Kirchner wire (K-wire) (Fig. A seven-hole 3.5-mm locking compression plate was used to stabilize the radius. After that, the patient underwent an open reduction and internal fixation of the radial fracture using a standard palmar approach of Henry. Under brachial plexus nerve block, reduction of the elbow dislocation was performed immediately, and radiographs confirmed the elbow to be in joint and tested stability. The patient was taken to the operating room three hours after arrival at the emergency department. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1–2 m in high-energy trauma. The “floating ulna” injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. Range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm. At the 12-month follow-up, the patient had no pain or signs of instability. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. Case presentationĪ 33-year-old female at 38 + weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. A few reports have described this type of injury and its treatment. Ipsilateral Galeazzi fracture with elbow dislocation, namely the “floating ulna” injury, is a rare injury pattern.
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