Easily missed fracture: distal radius and concomitant proximal ulna.

To cite: Seewoonarain S, Shakokani M, Pryke S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016214399 DESCRIPTION An 8-year-old girl presented to the emergency department following a fall from a climbing frame onto her outstretched left hand. On examination, the left wrist was swollen and tender. The skin was intact with no neurovascular compromise. The patient also reported pain in the left elbow, which was tender on palpation. Anteroposterior and lateral radiographs of the left forearm showed a fracture of the distal radius and proximal ulna (figures 1 and 2). The patient was placed in an above elbow backslab and reviewed by the orthopaedic team in the fracture clinic the following day, where the backslab was changed to a complete above elbow cast. At 1 month postinjury, it was changed to a futura splint. The patient made a full recovery. The Galeazzi fracture, comprising of a distal radial shaft fracture with associated distal radioulna joint injury, and the Monteggia fracture, composed of a proximal third ulna fracture and radial head instability, have both been described extensively. 2 We present a rare combination of a fracture of the distal radius fracture and proximal ulna with limited review in the literature. This was not an unusual mechanism of injury and a distal radius fracture is a common presentation to the emergency department. Care should always be taken to perform a systematic examination, identify whether the injury is closed or open, look for the presence of any neurovascular deficit, and to examine the joint above and below. These factors are vital to making the correct diagnosis and management.