Còn trật khớp quay – trụ dưới sau phẫu thuật điều trị gãy trật Galeazzi: Nguyên nhân, xử trí, cách phòng tránh – Nhân 2 trường hợp

Galeazzi fracture-dislocation, characterized by a radial shaft fracture combined with distal radioulnar joint (DRUJ) dislocation, presents a complex orthopedic challenge. While radial fixation is a relatively straightforward surgical procedure, persistent distal radioulnar joint dislocation postoperatively remains a not uncommon complication, often stemming from unrecognized associated injuries or insufficient intraoperative management. This leads to compromised wrist function and ongoing patient discomfort. Understanding the underlying causes and effective management strategies for these persistent dislocations is crucial for improving patient outcomes. This report aims to elucidate the mechanisms behind persistent distal radioulnar joint dislocation and propose comprehensive preventive and treatment approaches through the presentation of two clinical cases.

Orthopedic surgeons, residents, and medical students specializing in hand and wrist surgery, trauma surgery, and orthopedic rehabilitation.

This paper investigates the causes, management, and prevention of persistent distal radioulnar joint (DRUJ) dislocation following surgical treatment for Galeazzi fracture-dislocations through two detailed case reports. Both patients, aged 21 and 32, initially underwent radial fixation with plate and screws but subsequently experienced limited forearm supination and increased wrist pain, with X-rays confirming persistent DRUJ dislocation. Reoperation was necessary due to factors such as radial malalignment, interposition of the extensor carpi ulnaris tendon, and untreated ulnar styloid fractures leading to DRUJ locking. The corrective treatment involved radial osteotomy, open reduction of the DRUJ, fixation of the ulnar styloid fracture or triangular fibrocartilage complex repair, and temporary DRUJ stabilization with Kirschner wires, ultimately restoring full supination, pain relief, and stable DRUJ. The discussion highlights that a significant proportion (over 50%) of DRUJ dislocations are missed during initial surgery due to inadequate fracture reduction, soft tissue or bony fragment interposition, or failure to assess DRUJ instability. Therefore, accurate diagnosis and comprehensive intraoperative management of all associated injuries, particularly those causing locked DRUJ dislocations, are critical for preventing complications. The study concludes that persistent DRUJ dislocation after Galeazzi fracture fixation is a preventable complication, emphasizing anatomical reduction of both the radius and the DRUJ, and stabilization of the distal radioulnar joint when indicated. These findings underscore the importance of meticulous surgical technique and thorough assessment to avoid the need for revision surgery.