25520 Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation)

Name of the Procedure:

Closed Treatment of Radial Shaft Fracture and Closed Treatment of Dislocation of Distal Radioulnar Joint (Galeazzi Fracture/Dislocation)

Summary

The closed treatment of a radial shaft fracture and a dislocation of the distal radioulnar joint, commonly referred to as a Galeazzi fracture/dislocation, is a non-surgical method to realign and stabilize both a broken forearm bone (radius) and a displaced joint near the wrist.

Purpose

This procedure addresses the dual issue of a fractured radial shaft and the associated dislocation of the distal radioulnar joint. The goals are to realign the bones, restore joint function, and allow proper healing without the need for invasive surgery.

Indications

• Severe pain near the middle to lower part of the forearm
• Visible deformity or abnormal positioning of the forearm and wrist
• Inability to rotate or move the wrist or forearm properly
• Confirmed fracture and dislocation through imaging studies (e.g., X-rays)
• Acute injury resulting from trauma, falls, or direct impact

Preparation

• Fasting might be required if sedation is planned.
• Adjusting or stopping certain medications as advised by your healthcare provider.
• Obtaining pre-procedure imaging, such as X-rays or CT scans, to assess the fracture and dislocation.
• Discussing the procedure, risks, and benefits with the medical team.

Procedure Description

1. The patient is positioned comfortably, often on an exam table.
2. Sedation or local anesthesia may be administered to minimize discomfort.
3. The physician manually manipulates the bone fragments of the radius to realign them properly.
4. The dislocated distal radioulnar joint is then addressed by realigning it to its natural position.
5. Once alignment is achieved, the forearm is immobilized with a cast or splint.
6. Post-realignment X-rays are taken to confirm proper positioning.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the fracture and dislocation.

Setting

Usually performed in an emergency room, outpatient clinic, or a hospital setting.

Personnel

• Orthopedic surgeon or physician specializing in fracture management
• Nurse or medical assistant
• Radiology technician for imaging studies
• Anesthesiologist or nurse for sedation and pain management, if required

Risks and Complications

• Pain or discomfort during manipulation
• Incomplete fracture healing (nonunion)
• Improper bone alignment (malunion)
• Nerve or blood vessel injury
• Recurrence of dislocation
• Need for surgical intervention if closed treatment fails

Benefits

• Non-surgical approach with reduced recovery time
• Restoration of bone alignment and joint function
• Potentially lower risk of complications compared to surgery

Recovery

• Keeping the affected arm elevated to reduce swelling.
• Follow-up appointments for cast/splint adjustments and X-rays.
• Physical therapy may be recommended to restore movement and strength.
• Full recovery and return to normal activities can vary but typically take a few weeks to a few months.

Alternatives

• Surgical intervention (open reduction and internal fixation)
• Pros: Potentially more stable fixation, direct visualization of the fracture.
• Cons: Increased surgical risks, longer recovery time, potential for surgical complications.

Patient Experience

During the procedure, the patient might feel some pressure or discomfort, especially if sedation is not used. Post-procedure, there can be soreness and swelling. Pain can be managed with medications and elevation of the arm. The immobilization device (cast or splint) may cause some inconvenience but is essential for proper healing. Regular follow-up visits are necessary to monitor progress and adjust treatment if needed.