Piedmont fractures have been variably defined in the literature. Many suggest that Piedmont fractures are synonymous with Galeazzi fractures. That is a fracture of the radius at the middle and distal third with associated disruption of the distal radioulnar joint.
The initial report about the study of the Piedmont Orthopaedic Society is not entirely clear about an ulnar dislocation, which describes a closed fracture of the radial shaft at the junction of the middle and distal thirds without an associated fracture of the ulna 2. However, the society does describe distal radioulnar dislocation as a secondary complication of maltreatment and reference older literature that does not differentiate between Piedmont and Galeazzi fractures.
Others such as Greenspan 1, describe them as isolated radial fractures. That is, the same radial fracture as in a Galeazzi fracture, but without associated disruption of the distal radioulnar joint. It is the latter description that will be explored in this article.
The fracture appears infrequently 2 and so far we have found no age or gender related aspects.
Typically Piedmont fractures occur following a direct blow to the dorsoradial aspect of the forearm.
Plain films are usually sufficient for diagnosis and management planning. However, good quality orthogonal views are needed to identify correctly and characterise displacement. Features include:
- radial shaft fracture at the junction of the middle and distal third
- angulation of the distal fragment into the radioulnar space
- possible bony fragments
Treatment and prognosis
To achieve an acceptable functional result open reduction and internal fixation (ORIF) is typically required. Treated conservatively the interosseous space may be compromised with resulting loss of pronation and supination after bone reunion.
This definition refers to Adam Greenspan. There are other definitions not distinguishing between a Galeazzi and Piedmont fracture thus Greenspan is emphasising the non-associated disruption of the distal radioulnar joint with a Piedmont fracture.