Fracturedislocations

Fracture-dislocations are injuries in which a fracture of one bone occurs in conjunction with dislocation of an adjacent joint. They reflect substantial disruption of both bony and soft-tissue structures and are typically the result of high-energy trauma, though weakened bone from disease can predispose to these injuries. The pattern can involve many joints, but are most commonly described around the shoulder, elbow, forearm, wrist, knee, and ankle.

Common examples include Monteggia fracture-dislocations (fracture of the proximal ulna with dislocation of the radial head) and Galeazzi fracture-dislocations (distal radius fracture with dislocation of the distal radioulnar joint) in the forearm. Other patterns include shoulder fracture-dislocations with humeral head dislocation and associated head or glenoid fractures, as well as intra-articular injuries such as tibial plateau fracture-dislocations or pilon fractures with ankle joint involvement. The defining feature is the simultaneous occurrence of a fracture and a joint dislocation, creating instability that often requires both fracture fixation and joint realignment.

Diagnosis relies on a careful neurovascular examination and imaging. Plain radiographs in multiple views are standard; CT is often used to delineate complex intra-articular or marginal fractures, and MRI may help assess soft-tissue injuries when indicated.

Management emphasizes prompt reduction of the dislocation when feasible, followed by stabilization of the fracture and protection of soft tissues. Definitive treatment frequently involves surgical intervention, such as open reduction and internal fixation, though external fixation may be used in high-energy injuries or when soft-tissue conditions are unfavorable. Rehabilitation aims to restore range of motion while protecting repair. Complications include post-traumatic arthritis, stiffness, nonunion or malunion, and neurovascular compromise.