Tardy Ulnar Tunnel Syndrome Caused by Galeazzi Fracture-Dislocation: A Neuropathy With a New Pathomechanism

Abstract

We present a case of late-onset ulnar tunnel syndrome following a Colles fracture. The nerve palsy was caused by a vascular branch that stretched over the ulnar head, compressing the nerve and generating friction against the ulnar head when the forearm was rotated. This is the first report of such a pathomechanism.

Ulnar Nerve Injury as a Result of Galeazzi Fracture: A Case Report and Literature Review

“…6 Case discussion by Saitoh et al documents an intra-articular distal radius fracture that had associated median and ulnar nerve paresthesias. 17 Due to subsequent loss of reduction and planned corrective osteotomy, a computed tomography study was attained which demonstrated anterior dislocation of the ulna head from the sigmoid notch, thus justifying the author's stance of a Galeazzi variant type injury. Treatment consisted of decompression of the carpal tunnel and Guyon canal, division of a compressive adjacent vessel, and correction of the bony deformity resulting in full resolution of these sensory palsies over a 5-month period.…”

“…A review of the Galeazzi fracture literature demonstrates rare association with noniatrogenic nerve palsy. 6,8,15,17,19,21,22 Two of these, one each in an adult and an adolescent patient, are documented cases of anterior interosseous neuropraxia from closed injury with complete return of function after a series of months of observation. 19,21 The remaining articles all make mention of ulnar nerve palsy with Galeazzi fracture.…”

Subluxation-related ulnar neuropathy (SUN) syndrome related to distal radioulnar joint instability

“…Secondary causation has been associated with a ganglion (McDowell and Henceroth, 1977), cyst (Bowers and Doppelt, 1979), lipoma (Sakai et al, 2000), tortuous ulnar artery (Jose et al, 2006), giant cell tumour (Rengachary and Arjunan, 1981), carpal bone pathology (Greene and Hadied, 1981), anomalous muscles (Ruocco et al, 1998), and fibrous bands (Kochhar et al, 1973). Also described is ulnar nerve palsy as a direct consequence of distal radius fracture or from DRUJ degeneration subsequent to prior distal radius fracture (Clarke and Spencer, 1991; Frykman and Joshi, 1977; Saitoh et al, 2000; Vance and Gelberman, 1978). SUN syndrome is caused by DRUJ instability and could be considered a Type I subgroup of Shea and McClean’s classification: due to its intermittent nature, predominantly sensory.…”