![]() ( h) Postoperative site of the dorsal wrist. ( g) The entrapment of the fragment of the ulnar styloid was reduced. ( f) The fragment of the ulnar styloid was lifted up by the elevatrium. ( e) The elevatrium from the distal DRUJ portal was brought under the entrapped fragment of the ulnar styloid by guiding it to the radial side of the ulnar head. ( e- g) Schema of the procedures of reduction. The arrowhead indicates the view from the 3–4 portal ( a), and the arrow indicates the view from the proximal DRUJ portal ( b) and ( c). ( d) Schema of the arthroscopic procedure from ( a) to ( c). The sigmoid notch faces the ulnar head after the ulnar styloid is reduced. ( c) Arthroscopic view from the proximal DRUJ portal. ![]() A fragment of the ulnar styloid is trapped between the sigmoid notch and ulnar head. ( b) Arthroscopic view from the proximal distal radioulnar joint (DRUJ) portal. The triangular fibrocartilage complex (TFCC) extends over to the radial side. ( a) Arthroscopic view from the 3–4 portal. Photographs and schema of the wrist during and after arthroscopic treatment. Next, the distal ulna was approached from the ulnar side of the wrist, and the fragment of the ulnar styloid containing the distal and proximal components of the TFCC was avulsed from the fovea of the ulna and fixed using the tension band wiring (TBW) technique (Fig. Subsequently, the metaphyseal and articular fractures, including the third fragment of the radius, were fixed with a volar locking plate (2.4-mm Variable Angle LCP Two-Column Volar Distal Radius Plate DePuy Synthes, Tokyo, Japan). 2e-g) After reducing the fragment, the sigmoid notch faced the ulnar head (Fig. The elevatrium was brought under the fragment of the ulnar styloid by guiding it to the radial side of the ulnar head, and the fragment of the ulnar styloid was successfully reduced by lifting up the elevatrium. Using the viewing portal from the proximal DRUJ portal, we inserted an elevatrium from the distal DRUJ portal. Next, arthroscopy of the DRUJ was performed using distal and proximal DRUJ portals, and this showed ligamentous tissue, the TFCC, the sigmoid notch, and the cancellous bone, which was supposed to be the base of the ulnar styloid fragment (Fig. We tried to reduce the fragment of the ulnar styloid, but we could not visualize the ulnar side because of the triangular fibrocartilage complex (TFCC), which extended to the radial side (Fig. There were less than a 1-mm gap and step-off in the articular surface therefore, we judged that the articular surface was acceptably reduced. After the radius was exposed by the trans-flexor carpi radialis approach and reduced with a bone clamp, we evaluated the reduction of the articular surface of the radius by arthroscopy using 3–4 and 4–5 portals in the radiocarpal joint using a 30° oblique, 1.9-mm arthroscope (Stryker K.K., Tokyo, Japan). Operative treatment was performed under general anesthesia with air tourniquet control. We consider arthroscopic reduction to be superior to the open surgical method in terms of evaluating interpositions additionally, arthroscopic reduction is minimally invasive and does not need immobilization because it does not cause significant damage to the dorsal capsule and subsheath of the extensor carpi ulnaris, which comprise the triangular fibrocartilage complex. Less invasive reduction of the dorsal anatomical structure enabled our patient to return early to sports. The patient was asymptomatic and returned to the preinjury level of athletic activity 2 months postoperatively, and bone union of the radius and ulna was achieved without distal radioulnar joint instability 15 months postoperatively. A daily injection of parathyroid hormone and low-intensity pulsed ultrasound were used postoperatively. The metaphyseal and intra-articular fracture of the radius and the fragment of the ulnar styloid were fixed using a volar locking plate and tension band wiring technique, respectively. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. Operative treatment was performed using a 30° oblique, 1.9-mm arthroscope. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. We present the case of a 26-year-old man, a professional athlete, who sustained Galeazzi fracture-dislocation during a bicycle race. We aim to describe the surgical procedure involved in arthroscopic reduction of irreducible Galeazzi fracture-dislocation and clinical outcome and review the literature. Arthroscopy for the distal radioulnar joint of the wrist joint has recently been used for wrist pathology. There are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods.
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