PMC6250006_01
Anteroposterior (AP) and lateral radiographs of the humerus (a), forearm (b), and wrist (c) demonstrating a displaced left distal third humeral shaft fracture, a displaced left midshaft radius fracture with dislocation of the left distal radioulnar joint.
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Radiographs of the humerus, forearm, and wrist demonstrated a left distal third humeral shaft fracture (Figure 1(a)) as well as a left Galeazzi fracture, with a midshaft radius fracture and disruption of the distal radioulnar joint (Figures 1(b) and 1(c)).
Exposure of the posterior humerus through the Gerwin-Hotchkiss approach. (a) Intraoperative photograph of surgical exposure with retraction of the triceps mechanism medially demonstrating the humeral fracture site and the radial nerve in the spiral groove. (b) Intraoperative photograph after open reduction and internal fixation of the humeral shaft using an extraarticular locking plate.
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The intermuscular septum was divided distally approximately 3 centimeters, and then, the medial and lateral heads of the triceps muscle were then mobilized from lateral to medial along with the radial nerve to expose the posterior humeral shaft (Figure 2(a)). After reduction, a 3.5 mm extraarticular distal humerus plate (Depuy Synthes, West Chester, PA) was used for humerus fixation (Figure 2(b)).
One year postoperative AP and lateral radiographs of the left humerus (a), forearm (b), and wrist (c) demonstrating healing of both humeral and radial shaft fractures and maintenance of reduction of the distal radioulnar joint.
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At final follow-up 1 year postoperatively, radiographs demonstrated healed humeral and radial shaft fractures in anatomic position with stable reduction of the distal radioulnar joint (Figures 3(a)-3(c)).
Clinical photographs of the patient at 1 year postoperatively demonstrating elbow flexion and extension (a), forearm pronation and supination (b), and wrist flexion and extension (c).
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The patient is pain-free and has full range of motion (0-135 degrees flexion, 90 degrees of pronation and supination, and 85 degrees of wrist flexion and extension) and excellent clinical function (Figures 4(a)-4(c)).