Galeazzi fracture diagram8/27/2023 ![]() ![]() In the ED, closed reduction can be attempted. On an AP film, a break in Gilula’s arc/lines may be used to assess for a perilunate or lunate dislocation (Figure 2). In a perilunate dislocation, the lunate sits in line with the radius/ulna, however the capitate/metatarsal bones are dislocated dorsally. In a lunate dislocation, the lunate itself is physically removed or out of line with the rest of these bones (Figure 1, far right), resulting in the classic “spilled teacup” appearance on x-ray. In a normal lateral x-ray, these bones should all align (Figure 1, far left). The key to distinguishing these injuries on imaging is the alignment between the metacarpal, carpal, and the radius/ulna bones. Lunate and perilunate dislocations can be easily confused or mistaken for each other. The injury can be an isolated injury or associated with forearm fractures and should be tested for with every forearm injury as its presence can alter the disposition and even functionality of the patient. It has significant contributions to the axial load-bearing capabilities of the forearm. The distal radioulnar joint (DRUJ) consists of both the bony radioulnar articulation as well as the soft tissue components, including ligaments. What exactly is the distal radioulnar joint and why is it important? Each of these injuries should be carefully assessed for on physical exam and imaging. ![]() If found, these injuries can alter the management and disposition of the patient. Three less common injuries are reviewed here. Many of these injuries are uncomplicated, but an astute clinician can diagnose subtle and uncommon injury patterns. In the emergency department, orthopedic complaints make up a large percentage of presentations, up to 50% in the pediatric population and close to 33% in the adolescent and young adult population.
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