Piedmont fracture

Last revised by Calum Worsley on 2 Sep 2024

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. 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 initial report about the study of the Piedmont Orthopedic 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 references older literature that does not differentiate between Piedmont and Galeazzi fractures.

The fracture appears infrequently 2 and so far we have found no age or gender related predilection.

Piedmont fractures typically occur following a direct blow to the dorsoradial aspect of the forearm.

Plain radiographs are usually sufficient for diagnosis and management planning. However, good quality orthogonal views are needed to identify correctly and characterize 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

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 was described by Adam Greenspan, who emphasizes the lack of disruption of the distal radioulnar joint with a Piedmont fracture (unlike a Galeazzi fracture). Other definitions do not distinguish between a Galeazzi and Piedmont fracture.

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