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      Etude rétrospective des fractures de Galeazzi chez l’adulte dans le Département d’Orthopédie du Centre Hospitalier Universitaire Habib Bourguiba Sfax, Tunisie: à propos de 45 cas Translated title: Retrospective study of Galeazzi fractures in adults hospitalized in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia: about 45 cases

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          Abstract

          La fracture de Galeazzi est définie par l'association d'une fracture du radius et une luxation radio-ulnaire inférieure. Son diagnostic est souvent méconnu initialement. Le but de notre travail est de déterminer l'aspect épidémio-clinique des fractures luxation de Galeazzi chez l'adulte et d'apprécier les résultats fonctionnels et radiologiques de notre série. Il s'agit d'une étude rétrospective descriptive, sur une période allant de 2009 à 2018 colligée au Service d'Orthopédie du CHU Habib Bourguiba Sfax, portant sur 45 cas de fractures de Galeazzi traitées chirurgicalement. Nous avons utilisé le score de Mestdagh pour l'évaluation clinique de nos résultats. Le délai moyen de prise en charge était 5,35 jours. La synthèse du radius a été pratiquée par plaque vissée dans 39 cas et la radio-ulnaire a été embroché dans 13 cas. La consolidation a été obtenue dans un délai moyen de 10,5 semaines. Les résultats étaient excellents chez 35 patients, bon chez 3 patients, moyen chez 6 patients et mauvais chez un patient. Nous avons déploré 3 cas de sepsis sur broche et deux cas de cal vicieux. La fracture luxation de Galeazzi reste une entité sous diagnostiquée dans certains cas. Un examen dynamique peropératoire après synthèse solide du radius a permis d'avoir de bons résultats fonctionnels.

          Translated abstract

          Galeazzi fracture is defined as the association of radius fracture and inferior radioulnar joint dislocation. Its diagnosis is often unrecognized initially. The purpose of our study is to determine the epidemioclinical features of Galeazzi fracture-dislocations in adults and to assess the functional and radiological outcomes of our case series. We conducted a retrospective descriptive study of 45 patients with Galeazzi fractures treated surgically whose data were collected in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia, over a period ranging from 2009 to 2018. We used Mestdagh score for the clinical evaluation of the results. The mean time between fracture and treatment initiation was 5.35 days. Fixation of the radius was performed using screwed plate in 39 cases and fixation of the radio-ulnar joint using a plug in 13 cases. The average time for union was 10.5 weeks. Outcomes were excellent in 35 patients, good in 3 patients, medium in 6 patients and adverse in a patient. We had 3 cases of sepsis at the level of the plug and two cases of malunions. Galeazzi fracture-dislocation is an under diagnosed disorder in some cases. Dynamic intraoperative examination after solid fixation of the radius can allow for good functional results.

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          Most cited references26

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          Galeazzi fracture-dislocations.

          Z Mikíc (1975)
          Among 125 patients with the Galeazzi-type fracture-dislocation of the forearm, there were fourteen children and eighty-six adults with the classic Galeazzi lesion, and twenty-five patients with a special type -- fracture of both bones and dislocation of the distal radio-ulnar joint. Conservative management was successful only in children. In adults this method resulted in failure in 80 per cent of cases. The results of operative treatment were much better. The fracture fragments of the radius and the dislocation of the radio-ulnar joint in this complex injury are very unstable, especially in the lesion with fractures of the radius and ulna, and it appears that rigid internal fixation is necessary for the dislocation as well as the fracture. With combined fixation over half of the results were excellent.
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            The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.

            Ten fresh human upper-extremity cadaver specimens were tested for the effect of residual angulation from simulated fractures of both bones of the forearm on the potential for range of rotation of the forearm and for limitations of pronation and supination specifically. Ten and 20-degree angulations for the radius and ulna, such as might be encountered in all reasonable clinical situations, were tested. Little significant loss of forearm rotation resulted from angulations of 10 degrees in any direction. With 20 degrees of angulation, there was statistically significant and functionally important loss of forearm rotation. A residual angulation of 10 degrees in mid-shaft fractures of the radius, ulna, or both bones of the forearm will not limit forearm rotation anatomically. Loss in the range of rotation can be expected with residual angeles of 20 degrees or more.
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              Galeazzi fracture-dislocation: a new treatment-oriented classification.

              Forty patients with Galeazzi fracture-dislocations were treated with open reduction and internal fixation of the radial shaft fracture. Intraoperative distal radioulnar joint (DRUJ) instability after anatomic reduction was managed with supplemental wire transfixion of the DRUJ (10 patients) or open reduction and triangular fibrocartilage complex repair (3 patients). Two patterns of fracture-dislocation were identified based on the location of the radial shaft fracture. Twenty-two type I fractures were in the distal third of the radius within 7.5 cm of the midarticular surface of the distal radius; 12 of these cases were associated with intraoperative DRUJ instability. Eighteen type II fractures were in the middle third of the radial shaft more than 7.5 cm from the midarticular surface of the distal radius. Only one of these fractures had intraoperative DRUJ instability after open reduction and internal fixation of the radial shaft fracture. A high index of suspicion, early recognition, and acute treatment of DRUJ instability will avoid chronic problems in this complex injury.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                21 April 2020
                2020
                : 35
                : 135
                Affiliations
                [1 ]Service de Chirurgie Orthopédique et Traumatologie, CHU Habib Bourguiba, Sfax, Tunisie
                Author notes
                [& ]Auteur correspondant: Nizar Sahnoun, Service de Chirurgie Orthopédique et Traumatologie, CHU Habib Bourguiba, Sfax, Tunisie
                Article
                PAMJ-35-135
                10.11604/pamj.2020.35.135.22612
                7335257
                faf4cb13-11f0-4e8f-bd87-33f5713edb9f
                © Nizar Sahnoun et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 April 2020
                : 07 April 2020
                Categories
                Case Series

                Medicine
                fracture luxation de galeazzi,radius,traitement chirurgical,galeazzi fracture-dislocation,surgery

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