Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126, Turin, Italy.
Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, University of Turin, via Zuretti 29, 10126, Turin, Italy.
J Orthop Traumatol. 2020 Dec 2;21(1):21. doi: 10.1186/s10195-020-00562-8.
Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture-dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture-dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts.
A comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture-dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture-dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures].
Eighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture-dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture-dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors' knowledge, allowed us to include all types of dislocation and fracture-dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture-dislocations) of the forearm joint.
All injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture-dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment.
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孟氏、盖氏和埃斯克斯-洛夫雷蒂损伤是前臂最常见的骨折脱位类型。文献中偶尔会报道一些不常见的变体和罕见的外伤性前臂骨折脱位类型。在这项研究中，我们系统地回顾了文献，根据前臂关节和三锁概念，确定并分类所有前臂关节损伤类型。
根据涉及前臂骨折脱位的主要病理条件，对 PubMed 数据库进行全面搜索。寻找埃斯克斯-洛夫雷蒂损伤、孟氏和盖氏骨折脱位以及近侧和/或远侧桡尺关节脱位。在检索到文章后，使用以下数字算法对前臂损伤类型进行分类：近侧前臂关节 1[包括伴有或不伴有桡骨头骨折的近侧桡尺关节（PRUJ）脱位]、中间桡尺关节 2、如果伴有桡骨骨折 R、如果伴有骨间膜破裂 I、如果伴有尺骨骨折 U 和远侧桡尺关节 3[包括伴有或不伴有远侧桡骨骨折的远侧桡尺关节（DRUJ）脱位]。
通过 PubMed 共检索到 884 篇文章，经过文献研究、去重和研究筛选，选择了 462 篇文章。根据排除标准，纳入了 44 篇描述非典型前臂骨折脱位的全文文章。另外，分别加入了 3 篇历史综述。我们发现了一些二锁损伤的罕见模式，有时会使用不正确的变体或等效的孟氏和盖氏损伤类型来描述。此外，我们还发现了一组除埃斯克斯-洛夫雷蒂以外的三锁损伤，与尺骨和/或桡骨骨干骨折有关，导致纵向不稳定。除了通常使用历史术语（孟氏、盖氏和埃斯克斯-洛夫雷蒂）描述的骨折脱位外，我们的分类系统，据作者所知，还允许我们包括文献中报告的所有类型的前臂关节脱位和骨折脱位。根据这种分类，与肘部类似，我们可以区分前臂关节的单纯脱位和复杂脱位（骨折脱位）。
所有损伤类型都可以使用字母数字代码预先识别。这可能有助于避免前臂骨折脱位命名的混淆，并帮助外科医生发现病变，指导手术治疗。
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