Fracture–dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system

Abstract

Background 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. Methods 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]. Results 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. Conclusions 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. Level of evidence V.

Monteggia variant with posterior elbow dislocation and radial shaft fracture: A case report

“…Artiaco et al proposed a classification system for forearm and Monteggia variant fractures. This system is based on a “locker” concept which is extrapolated from the functional and anatomic joints of the forearm as described above in the introduction [12] . There are 13 fracture patterns described.…”

“…In brief, a number one signifies the proximal forearm joint including the PRUJ, two signifies the middle radioulnar joint consisting of the forearm bones and interosseous membrane, and three is indicative of the DRUJ. There are also letters to be added, R stands for concomitant radius fracture, I meaning IOM rupture, and U implying concomitant ulna fracture [12] . This classification system is more inclusive of variants or equivalents of Monteggia fractures, but is not commonly utilized.…”

Increasing consensus on terminology of Achilles tendon-related disorders

“…In systematic reviews, many eponymous diagnosis have to be converted to anatomical diagnostic groupings and at all studies are excluded based on aberrant or uninterpretable definitions of an eponym or pathology, which can lead to different research results which are often leading for the best scientific-based treatment in clinical practice [ 2 , 9 , 27 ].…”

Both Bone Forearm Fracture with Complex DRUJ Dislocation: What Are the Odds?

“…2,4,8 In a comprehensive three-locker based classification, the combination of BBFA fracture with DRUJ dislocation has been classified as 2RIU.3. 1 The mechanism of both bone forearm fracture in combination with DRUJ dislocation is difficult to explain. The force passing through radius and then exiting through the ulna and DRUJ is unlikely.…”