Gadegone Wasudeo M, Salphale Yogesh, Magarkar Ds
Department of Orthopedics and Traumatology, Chandrapur Multispecialty Hospital, Mul Road, Chandrapur - 442 401, India.
Indian J Orthop. 2010 Oct;44(4):448-52. doi: 10.4103/0019-5413.67121.
A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radio-ulnar joint (DRUJ). The conventional surgical technique of nailing does not give enough stability and open reduction, internal fixation with the plate is associated with numerous complications. The stacked nailing for the management of these injuries provides adequate stability, maintains the relationship of the DRUJ and promotes uneventful union by closed technique. The purpose of this study is to evaluate the results of simple, user-friendly, low cost elastic stacked nailing for the management of Galeazzi fracture dislocation.
We treated 22 young adults with fresh Galeazzi fracture-dislocation of the forearm, from January 2004 to January 2008, by percutaneous fixation of fracture by stacked elastic nailing at our institute. There were 19 males and three females and the age group ranged from 20-56 years (average 35 years). Surgery was performed within 48 to 72 hours under the guidance of image intensifier. Medullary cavity was filled with two elastic titanium nails having unequal lengths and diameter. One nail acts as a reduction nail and the other acts as a stabilizing nail. The results were evaluated using Mikic criteria based on union, alignment, relationship of the DRUJ, and movements at the inferior radio ulnar joint, elbow and wrist.
In six cases, following radiological union, nails in the radius were extracted between six to nine months after operation because of discomfort complained by the patient at site of insertion. After one year follow-up, 18 patients had excellent, four had fair results.
Closed reduction and internal fixation of Galeazzi fracture by two elastic rods re-establishes the normal relationship of the fractured fragments and the DRUJ without repair of the ligaments. The stability is achieved by the flexibility and elasticity of the nails, crowding of the medullary canal and anchorage they gain in the radial diaphysis. Elastic nailing can produce excellent clinical results for Galeazzi fracture-dislocation. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve.
盖氏骨折被定义为桡骨骨折合并下尺桡关节（DRUJ）脱位。传统的髓内钉手术技术稳定性不足，而切开复位钢板内固定则伴有诸多并发症。用于治疗这些损伤的堆叠式髓内钉提供了足够的稳定性，维持了下尺桡关节的关系，并通过闭合技术促进了顺利愈合。本研究的目的是评估简单、易用、低成本的弹性堆叠式髓内钉治疗盖氏骨折脱位的效果。
2004年1月至2008年1月，我们在本机构对22例前臂新鲜盖氏骨折脱位的年轻成人患者采用经皮堆叠弹性髓内钉固定骨折。其中男性19例，女性3例，年龄范围为20 - 56岁（平均35岁）。在影像增强器引导下于48至72小时内进行手术。髓腔内插入两根长度和直径不等的弹性钛钉。一根钉子作为复位钉，另一根作为稳定钉。根据Mikic标准，基于骨折愈合、对线、下尺桡关节关系以及尺桡远侧关节、肘部和腕部的活动情况对结果进行评估。
6例患者在影像学骨折愈合后，因患者诉植入部位不适，于术后6至9个月取出桡骨内的钉子。随访一年后，18例患者效果优秀，4例效果尚可。
通过两根弹性棒对盖氏骨折进行闭合复位和内固定，无需修复韧带即可重建骨折碎片与下尺桡关节的正常关系。稳定性通过钉子的柔韧性和弹性、髓腔的挤压以及它们在桡骨干中获得的锚固来实现。弹性髓内钉治疗盖氏骨折脱位可产生优异的临床效果。它具有技术简单、成本低、器械易用且学习曲线短的优点。
