Imaging Findings

The frontal and lateral X-ray images of the patient’s forearm and wrist show: a visible fracture line in the radial shaft at the junction of the middle and distal segments, appearing as a short oblique or nearly transverse fracture line. The distal fragment is displaced toward the ulnar side. Accompanying this, abnormal alignment is seen in the distal radioulnar joint, suggesting dislocation of the ulnar head, which has shifted dorsally and medially relative to normal alignment. Significant surrounding soft tissue swelling is noted, but there is no clear evidence of intra-articular loose bone fragments. There is no explicit indication of a fracture in the ulnar shaft itself; however, an avulsion fracture of the ulnar styloid or ulnar head is suspected. Further clinical assessment is recommended.

Possible Diagnoses

1. Galeazzi Fracture-Dislocation: Typically involves a fracture of the radial shaft (often in the middle-distal region) with dislocation of the distal radioulnar joint. Radiographic findings support this diagnosis.
2. Piedmont Fracture (Synonymous with Galeazzi Fracture): Another term used in some literature to describe the same type of fracture.
3. Other Variations of Forearm Fractures with Joint Dislocation: For instance, if the ulnar head or styloid fracture were more prominent, there could be combined injuries. However, when a radial shaft fracture is localized and clearly associated with distal radioulnar joint dislocation, it most closely aligns with the characteristics of a Galeazzi fracture-dislocation.

Final Diagnosis

Taking into account the trauma mechanism (motor vehicle accident), clinical presentation (pain and functional impairment at the distal radioulnar joint), and the X-ray findings of a radial shaft fracture with dislocation of the distal radioulnar joint, the most likely diagnosis is:

Galeazzi Fracture-Dislocation (fracture of the radial shaft with distal radioulnar joint dislocation).

Treatment Plan and Rehabilitation

Since Galeazzi fracture-dislocation is inherently unstable, standard treatment generally involves surgical fixation. During surgery, the dislocation of the radioulnar joint is corrected.

1. Treatment Strategy
   • If there is significant fracture displacement or if the joint dislocation cannot be reduced by closed means, open reduction and internal fixation (ORIF) is indicated. This typically involves using plates and screws to stabilize the radial shaft fracture and evaluating, repairing, or stabilizing the distal radioulnar joint.
   • If there is an associated triangular fibrocartilage complex (TFCC) injury, it can be repaired under arthroscopic or direct visualization.
   • If the fracture line is relatively simple with acceptable displacement, and the distal radioulnar joint can be reduced by closed means, conservative treatment (casting or bracing) may be attempted. However, most cases require surgery to ensure a good long-term functional outcome.
2. Rehabilitation and Exercise Prescription
   • Early Stage (Postoperative or Immobilization Period):
     • Maintain stability at the fracture site and avoid excessive rotation or weight-bearing.
     • Under the guidance of a physician or therapist, perform range of motion exercises for the shoulder, elbow, and fingers to prevent joint stiffness and muscle atrophy.
     • Engage in low-intensity isometric muscle training (such as gentle fist clenching and releasing) 2-3 times per day for 5-10 minutes per session.
   • Intermediate Stage (After Removing Immobilization/Initial Fracture Healing):
     • Once imaging confirms fracture stability, gradually increase wrist and forearm rotational activities, as well as strengthen the forearm and grip using hand exercisers or resistance bands.
     • Perform exercises 3-4 times a week, 15-20 minutes each session, ensuring the intensity does not cause significant pain.
     • Under professional supervision, engage in both passive and active joint range of motion exercises to further enhance forearm rotation and wrist flexibility.
   • Late Stage (Fracture Fully Stabilized/Functional Recovery):
     • Gradually introduce weight-bearing exercises such as light dumbbells or resistance training to improve forearm muscle strength and joint coordination.
     • Depending on individual fitness, incorporate aerobic activities (e.g., cycling, swimming) to promote overall recovery. Aim for 3-5 sessions per week, each lasting 20-30 minutes.
     • Integrate forearm and wrist mobility and endurance tasks into daily activities in a progressive manner, avoiding a rapid increase in load.

   Throughout the rehabilitation process, training plans should be continuously adjusted under the guidance of a rehabilitation specialist or an orthopedic surgeon, based on the degree of fracture healing, pain level, and functional recovery, to prevent secondary injuries.

Disclaimer

This report provides a reference for medical imaging analysis and general rehabilitation guidelines and does not replace an in-person consultation or professional medical diagnosis and treatment. If symptoms persist or worsen, or if you have any other concerns, please seek medical attention promptly and follow the instructions of a specialist.