5. Primary Survey
• A : can talk, not tender along C- spine, neck full ROM
• B : spontaneous breathing, equal chest expansion, equal breath sound,
clear both lung, CCT negative
• C : BP 128/65 mmHg, Heart rate 78/min, capillary refill < 2 sec, PCT
negative
• D : E4V5M6, pupil 3 mm RTLBE, motor grade V all extremities
• E : left periorbital edema and ecchymosis, abrasion wound
at frontal area 2x2 cm, abrasion wound at left hand 1x1 cm x 3 area
6. Primary Survey
• E : abrasion wound at left ankle 1x1 cm x 3 area,
left forearm : swelling, deformity, limit ROM due to pain,
neurovascular intact, capillary refill < 2 sec
9. Secondary Survey
• A : ปฏิเสธประวัติแพ้ยา, อาหาร
• M : ยารักษาโรคความดันโลหิตสูง, ไขมันในเลือดสูง
• P : HT, DLP
• L : last meal at 12.00 น. ( 7 ชั่วโมงก่อนมาโรงพยาบาล)
• E : ขณะกาลังขี่รถจักรยานกลับบ้าน มีสุนัขวิ่งตัดหน้ารถจักรยานยนต์
ผู้ป่วยขี่หลีกหนีจึงทาให้รถเสียหลักล้ม
10. Physical Examination
• V/S : BP 128/65mmHg, BT 37.5 , HR 78/min, RR 18/min
• GA : A middle age Thai woman, good consciousness, E4V5M6
• HEENT : not pale conjunctiva, anicteric sclera, no cervical
lymphadenopathy, left periorbital edema and ecchymosis, AW 2x2 cm
at frontal area
• Heart : normal S1,S2 , no murmur, full and regular pulse
• Chest : equal chest movement, no stridor, clear and equal
breath sound, trachea in midline, equal tympanic on percussion
11. Physical Examination
• Abdomen : soft, not tender, no rebound tenderness, no guarding
• Neuro : pupil 3 mm RTLBE, motor grade V all ext., sensory intact,
reflex 2 + all (left upper limb can’t evaluate)
• Extremity : abrasion wound at left hand 1x1 cm x 3 area, abrasion
wound at left ankle 1x1 cm x 3 area,
left forearm : swelling, deformity, limit ROM due to pain,
neurovascular intact, capillary refill < 2 sec
16. Galeazzi Fracture
• Definition
– distal 1/3 radius shaft fracture and associated distal
radioulnar joint (DRUJ) injury
• Incidence of DRUJ instability
– if radial fracture is <7.5 cm from articular surface
• unstable in 55%
– if radial fracture is >7.5 cm from articular
surface
• unstable in 6%
17. Galeazzi Fracture
• Mechanism
– direct wrist trauma
• typically dorsolateral aspect
– fall onto outstretched hand with forearm
in pronation
19. Galeazzi Fracture
• Presentation
– Symptoms : pain, swelling, deformity
– Physical examination
• Point tenderness over fracture site
• ROM : test forearm supination and pronation
for instability
• DRUJ stress : wrist or midline forearm pain
21. Galeazzi Fracture
Signs of DRUJ injury
– ulnar styloid fx
– widening of joint on AP view
– dorsal or volar displacement on
lateral view
– radial shortening (≥5mm)
22. Galeazzi Fracture
• Treatment
• Operation : ORIF of radius with reduction and
stabilization of DRUJ
• indications
– all cases, as anatomic reduction of DRUJ is required
– acute operative treatment far superior to late
reconstruction