Skip to main content

Post-traumatic distal ulnar bifurcation in children: a case report



Galeazzi fracture dislocation is a compound injury that encompasses fractures of the distal third of the radius and dislocation of the distal radial ulnar joint (DRUJ). Clinically, this condition is rare and often leads to distal ulnar bifurcation. In previous similar reports, patients were effectively managed through surgery.

Case presentation

In this case report, we describe an 11-year-old male child who presented with an ulnar bifida following trauma to the hand, and was treated with manipulation and conservative treatment without surgery. A follow-up performed over the years demonstrated that the patient recovered well, and had normal wrist movements without significant pain, and the patient expressed great satisfaction.


Ulnar diaphyseal fracture may occur in children or adolescents due to injuries, and may be accompanied with manipulation and repositioning. Conservative treatment can be applied to avoid the trauma associated with surgery especially in the absence of severe joint mobility impairment with good outcomes.

Peer Review reports


Galeazzi aequivalent fracture dislocation is a compound injury that comprises fractures of the distal third of the radius and dislocation of the distal radial ulnar joint (DRUJ), which is prevalent among adults [1]. In children or adolescents, Galeazzi equivalent fracture dislocation manifests as distal ulnar epiphyseal separation rather than true distal radial ulnar dislocation (DRUJ) [2, 3]. This Galeazzi aequivalent fracture in fact represents a Salter Harris type I or II (or in rare instances a Salter -Harris type IV) injury. Some small epiphyseal injuries may be difficult to detect using imaging techniques and are often overlooked [4]. Here, we report a case of an abnormal distal ulnar bifurcation after trauma with a “Y” shape on imaging. The first case was reported in 2013 by Jones et al. and was successfully treated via surgical operation [5]. In the present report, the patient was treated for bifid ulna conservatively and followed up for 7 years, hence our case presents the entire progression of the patient who received conservative treatment, which is now functioning normally in the wrist.

Case presentation

The patient in this case was an 11-year-old male who fell while running and injured his left wrist(We have obtained the consent of the patients and their families regarding sharing information associated with the patient). An X-ray examination at the local hospital revealed a fracture of the distal radius and dislocation of the distal ulnar radial joint. The doctor at the hospital administered the patient 2 manipulations and plaster fixation. Two months later, the patient presented to our hospital due to local swelling and pain. An initial examination of the injury site found no signs of neurovascular damage, but there was pain at the left upper ulnar radial joint, dorsal ulnar bony projection of the left wrist with slight local swelling and significant tenderness. The left wrist joint had nearly unrestricted extension and flexion, but its rotational ability, particularly supination, was limited (Fig. 1).

Fig. 1
figure 1

(A) X-ray of the patient at the time of injury, greenstick fracture of the left radius (Arrow) with possible dislocation of the distal ulna at the DRUJ. (B) The patient’s hand movement, X-ray and CT 3D reconstruction 2 months after the injury

We performed an X-ray of the injured site and found that the distal left ulna was split and a new ulna was growing. With the consent of the patient’s family, we performed a CT examination of the area which clearly revealed the deformity was more clearly (Fig. 1). The new ulna grew inwards, was slightly smaller than the original ulna and did not have a complete articular surface, while the normal original ulna protrudes dorsally and laterally with an intact articular surface and a “Y” shaped distal ulna. The patient exhibited normal wrist flexion and extension, but had limited rotation. Following a discussion, the patient’s parents declined surgical treatment. Consequently, we recommended functional exercise and regular follow-up to manage the condition. After a period of seven months, the patient returned to us as a result of experiencing pain. Examination showed that the showed that the pain in the left upper ulnar radius had almost disappeared and the rotation of the left wrist had improved, but there was still pain on extreme supination. The x-ray showed that the distal ulnar bifurcation was still visible, but the two bifurcated ulnae were close to each other and the base was decreased compared with that at 2 months after injury (Fig. 2).

Fig. 2
figure 2

Functional activity and X-ray of the patient’s hand at 7 months post-injury follow-up

The patient presented to our hospital at 3 years (Fig. 3) and 7 years (Fig. 4) after the injury. At the last follow-up, the patient’s status was that of a university student, not yet in the workforce. The patient’s left wrist function recovered satisfactorily and did not interfere with his daily life or physical activity, including playing basketball, push-ups and lifting heavy objects. A physical examination revealed that the length of the forearms were equal, the left elbow joint was normal, the left wrist deformity was minimal, the left ulnar styloid process was not prominent, there was no obvious local tenderness, the left wrist extension and flexion and rotation range of activities were normal. However, there was mild pain around the ulnar styloid process on extreme posterior rotation of the left wrist. The X-ray showed that the distal ulna was shortened and bifurcated, but the ulnar bifurcation was atrophied and smaller than previously, the ulnar styloid process was deformed and enlarged, the inferior ulnar radial joint was dislocated, the distal ulna did not participate in the composition of the radial carpal joint, and there was no obvious deformity of the radius.

Fig. 3
figure 3

Movement and X-rays at 3 years of follow-up

Fig. 4
figure 4

Movement and X-rays at 7 years of follow-up

When performing activities of daily living (ADLs), the normal functional range of wrist motion is 5 degrees of flexion, 30 degrees of extension, 10 degrees of radial deviation and 15 degrees of ulnar deviation [6, 7]. During the follow-up visits, we recorded the patient’s range of motion including wrist flexion and extension, ulnar and radial deviation of the wrist, and anterior/posterior rotation of the forearm (Table 1). The wrist function was rated following the criteria proposed by Krimmer et al. [8].

Table 1 Range of motion of the patient’s left wrist at post-injury follow-up


The first such case of Galeazzi aequivalent fracture dislocation was reported by Jones et al. in 2013 [5], in which a 19-year-old man who had undergone surgery for a left wrist injury 12 months later presented with loss of internal and external rotation. Examination revealed a bifurcation of the distal ulna, which they understood at the time to be an occult ulnar injury following an injury that was difficult to detect on imaging. This may have led to an osteochondroma-like lesion growing towards the joint and forming a second ulnar head. In the end, a surgical procedure was performed to remove the head of the distal end of one of the ulna bones. However, the finding of osteochondroma-like lesion has since been questioned, and one such case has been reported and discussed in detail. They argued that the previous claim was questionable due to various reasons. Consequently, they suggested that the new ulna was probably the result of a periosteal cuff injury, followed by subperiosteal ossification and a bifid ulna which was surgically treated [9]. The treatment options for bifid ulna have been explored in recent literature [10]. The authors propose two surgical approaches, i.e. removal of the palmar limb or the dorsal limb. They also suggest that the time of injury is a crucial factor, and that anatomical reconstruction (resection of the palmar limb) should be conducted as early as possible, and a simple dorsal limb resection can be performed if the injury is longer or if a corrective radial osteotomy has been carried out [10]. With regard to the mechanism of formation of the new ulna, we also believe that it was due to subperiosteal ossification. At the time of injury, the patient fell and developed the injury and wrist rotation, causing the ulnar periosteum to tear away owing to the pulling of the interosseous membrane of the forearm. These alterations were not fully aligned at the time of the manipulation, which lead to the tearing of the periosteum and subperiosteal ossification to form a new ulna. In previous cases, surgical treatment was applied [5, 9, 10]. In the present report, the patient was 11 years old at the time of the injury and had no significant restriction of hand movement after the injury and showed only mild restriction of rotational function after the new ulna had grown out. Subsequent follow-up showed that the conservative treatment had effectively restored functional movement to normal state.


We report a case of post-traumatic distal ulnar bifurcation, which may also be referred to as a bifurcated ulna, and demonstrate for the first time the course and prognosis of the bifurcated ulna after conservative treatment. In children and adolescents presenting with a bifid ulna after a Galeazzi equivalent fracture, conservative treatment after repositioning may be attempted in patients whose motor function is not significantly limited to avoid the trauma associated with surgery. we think prospective multi-center studies are required to find out more about the most efficient treatment of Galeazzi aequivalent injury in adolescents.

Data Availability

All data generated or analyzed during this study are included in this published article.



Distal radial ulnar joint


Computed tomography


Activities of daily living






  1. Kamano M, Ko H, Kazuki K. Paediatric Galeazzi-equivalent fracture: two case reports. Hand surgery: an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2005;10(2–3):249–54.

  2. Castellanos J, Ramírez-Ezquerro C, de Sena L, Cavanilles-Walker JM. Irreducible fracture-separation of the distal ulnar epiphysis in the Galeazzi equivalent fracture–a case report. Acta Orthop Scand. 1999;70(6):634–6.

    Article  CAS  PubMed  Google Scholar 

  3. Maeda H, Yoshida K, Doi R, Omori O. Combined Monteggia and Galeazzi fractures in a child: a case report and review of the literature. J Orthop Trauma. 2003;17(2):128–31.

    Article  PubMed  Google Scholar 

  4. Walsh HP, McLaren CA, Owen R. Galeazzi fractures in children. J bone joint Surg Br volume. 1987;69(5):730–3.

    Article  CAS  Google Scholar 

  5. Jones C, Li H, Ellahee N. An anomalous bifid distal ulna: a case report. Int J Surg Case Rep. 2013;4(11):939–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ryu JY, Cooney WP 3rd, Askew LJ, An KN, Chao EY. Functional ranges of motion of the wrist joint. J Hand Surg Am. 1991;16(3):409–19.

    Article  CAS  PubMed  Google Scholar 

  7. Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am. 1985;10(1):39–46.

    Article  CAS  PubMed  Google Scholar 

  8. Krimmer H, Wiemer P, Kalb K. [Comparative outcome assessment of the wrist joint–mediocarpal partial arthrodesis and total arthrodesis]. Handchirurgie, Mikrochirurgie, plastische chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der. Peripheren Nerven und Gefasse. 2000;32(6):369–74.

    CAS  Google Scholar 

  9. Wu JC, Lilly R, Vara AD, Sobol G. Posttraumatic bifid Ulna in a Pediatric Galeazzi-Equivalent Forearm fracture. J Hand Surg Am. 2019;44(9):802. e1- e8.

    Article  Google Scholar 

  10. Mella J, Sommarhem A, Pääkkönen M. Treatment Options for Bifid Ulna Deformity following Galeazzi-equivalent Injury in Adolescents. J hand Surg Asian-Pacific volume. 2022;27(2):370–5.

    Article  Google Scholar 

Download references


Thank you to everyone who participated in this report.


This work was supported by the National Natural Science Foundation of China under Grant (No. 82060395) and the University-Enterprise Joint Project of Central South University (2022XQLH184).

Author information

Authors and Affiliations



LHT, WJ and ZY contributed to manuscript drafting and conceived the study. LSH has collated the images. CL, LZY ZSS and SBH contributed to revise the manuscript with significant input. All authors reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hai-Tao Long.

Ethics declarations

Ethics approval and consent to participate

All procedures followed were in accordance with the Declaration of Helsinki and informed consent was obtained from study participants prior to the writing of case reports.

Consent for publication

Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

Competing interests

All authors declare that they have no conflicts of interest concerning this study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, J., Zhu, Y., Lin, ZY. et al. Post-traumatic distal ulnar bifurcation in children: a case report. BMC Musculoskelet Disord 24, 430 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Galeazzi aequivalent fracture
  • Conservative treatment
  • Joint dislocation
  • Ulna Fractures