When to Suspect DRUJ's Instability in Children? Case Report of a Rare Presentation of Distal Forearm Fractures

Abstract

Pediatric displaced distal metaphyseal ulnar fractures and distal radial buckle fractures are common. However, to the best of our knowledge, their association has never been specifically reported. Thus, classification and management of this pattern remain challenging especially in young children. Distal radioulnar joint (DRUJ)'s assessment is difficult. A Galeazzi-equivalent injury should be suspected. We report the case of a 2-year-old boy who presented the above-mentioned association of forearm fractures and compare our management with actual recommendations. We would recommend a low-suspicion threshold for DRUJ's instability in young children presenting with displaced distal metaphyseal ulnar fracture associated with distal radial buckle fracture. That suspicion should raise the necessity of appropriate treatment and follow-up.

Pediatric Wrist

“…64 Clinical evaluation of the DRUJ may be challenging initially, especially in young children who are in pain. 63,65 In contrast to adults, a Galeazzi fracture in children can often be treated successfully with closed reduction and casting, yielding good outcomes despite possible initial misrecognition. 63,65 Galeazzi-equivalent injuries are categorized based on the Letts and Rowhani classification.…”

“…63,65 In contrast to adults, a Galeazzi fracture in children can often be treated successfully with closed reduction and casting, yielding good outcomes despite possible initial misrecognition. 63,65 Galeazzi-equivalent injuries are categorized based on the Letts and Rowhani classification. 63 Children with Galeazzi-equivalent injuries are typically managed through closed reduction and immobilization in an aboveelbow plaster cast for 4 to 6 weeks.…”

“…64 Clinical evaluation of the DRUJ may be challenging initially, especially in young children who are in pain. 63 65…”

“…However, misdiagnosis or improper treatment could potentially impact the stability of the DRUJ, limit wrist and forearm range of motion, and lead to chronic pain. 65…”