Fracture–Dislocations of the Forearm Axis Due to Ballistic Injuries: A Single-Institution Case Series

Abstract Fracture–dislocations of the forearm axis that are better known by their eponyms Galeazzi and Monteggia injuries are classically described as a result of blunt trauma. We commonly treat ballistic injuries at our institution and have seen fracture–dislocations of the forearm axis occur as a result. However, this is not previously well-described, as there is only one such case report in the literature. In this study, we present a series of patients with fracture–dislocations of the forearm axis due to a ballistic mechanism. We conducted a retrospective chart review of patients with forearm fractures presenting to our institution between 2012 and 2021. Only those with forearm fractures due to ballistic injuries were included. Radiographs and clinical examination were used to evaluate and describe the injuries. Patient charts were reviewed, and data including patient demographics, injury characteristics, management, complications, and outcomes were collected. In total, 152 patients with forearm fractures secondary to ballistic injuries were identified. Of these patients, seven sustained a fracture of the radius with a distal radioulnar joint injury. There were no patients who had a fracture of the ulna with a concomitant proximal radioulnar joint injury. One patient had a vascular injury requiring an interposition graft. Three patients had nerve injuries; two were diagnosed as neuropraxia that improved at follow-up, whereas the third was lost to follow-up. Six of the seven patients included in this study underwent operative fixation, whereas one was lost to follow-up. One patient developed a malunion and required a corrective osteotomy. None of the patients developed an infection. Ballistic injuries to the forearm can result in fracture–dislocations of the forearm axis. Orthopaedic surgeons should maintain a high index of suspicion for these injury patterns when managing forearm fractures due to a firearm injury. V.