Rockwood Children CH8

246

SECTION TWO • Upper Extremity

A

B Figure 8-4.  Radiographic images of the gymnast’s wrist. A: AP radiograph of the left wrist in a 12-year-old female demonstrates physeal widening, cystic changes, and metaphyseal sclerosis. B: AP radiograph of the same wrist after 3 months of rest from gymnastics, demonstrating incomplete resolution of the physeal changes.

ipsilateral extremity fractures. 184 Associated fractures of the hand and elbow regions need to be assessed because their pres- ence implies more severe trauma. For example, the incidence of a compartment syndrome is higher with a “floating elbow” combination of radial, ulnar, and elbow fractures. 173 With marked radial or ulnar fracture displacement, neuro- vascular compromise can occur. 15,44,205 Median neuropathy may be seen in severely displaced distal radius fractures, due to direct

INJURIES ASSOCIATED WITH FRACTURES OF THE DISTAL RADIUS AND ULNA

The risk of associated injuries is significantly less in the skel- etally immature as compared to skeletally mature patients. 58 The entire ipsilateral extremity should be carefully examined for fractures of the carpus, forearm, or elbow. 12,32,91,120,173,184,195 Indeed, 3% to 13% of distal radial fractures have associated

A

B

Figure 8-5.  Supination-type Galeazzi fracture. A: View of the entire forearm of an 11-year-old boy with a Galeazzi fracture–dislocation. B: Close-up of the distal forearm shows that there has been disruption of the distal radioulnar joint ( arrows ). The distal radial fragment is dorsally displaced (apex volar), making this a supination type of mechanism. Note that the distal ulna is volar to the distal radius.