Galeazzi Fractures

Introduction

Defined as distal 1/3 radius shaft fx with an associated distal radioulnar joint (DRUJ) injury

Imaging

Radiographic signs of DRUJ injury
1. ulnar styloid fx
2. widening of joint on AP view
3. dorsal or volar displacement on lateral view
4. radial shortening (~ 5mm)

Treatment

Acute operative treatment far superior to late reconstruction
- requires anatomic reduction of DRUJ
Perform
- anatomic plate fixation of radius shaft
- reduction and stabilization of DRUJ (casting or pinning)

Surgical Techniques

Approach
- radius - Volar (Henry) approach to radius
- DRUJ - Dorsal capsulotomy
Perform anatomic plate fixation of radius shaft
- place 3.5 DCP on radius
Stabilization of DRUJ
- treat with reduction and
  - immobilization in supination for 6 weeks or
  - temporary percutaneous pin fixation for 4 weeks in neutral (may remove in office)
- if irreducible suspect interposition of ECU tendon
  - surgically open and remove

Complications

Compartment Syndrome
- increased risk with
  1. high energy crush injury
  2. open fxs
  3. vascular injuries or coagulopathies (DIC)
- diagnosis
  - pain with passive stretch is most sensitive
Neurovascular injury
- uncommon except
  - Type III open fxs
Refracture following plate removal
- increased risk with
  1. removing plate too early
  2. large plates (4.5mm)
  3. comminuted fx
  4. persistent radiographic lucency
- dont remove plates before 18 mos (this is how long it takes to get complete primary bone healing)

References

Review of Orthopaedics, 4th Edition, Mark D. Miller, W B Saunders Co, March 2004
Orthopaedic Knowledge Update 8: Home study syllabus, Edited by Alexander R. Vaccaro, MD
Miller Colorado Review Lecture Series , Mark D. Miller, Stryker, 2005
Handbook of Fractures, Joseph D. Zuckerman, Kenneth J. Koval
Surgical Exposures in Orthopaedics: The Anatomic Approach, Stanley Hoppenfeld, Piet DeBoer
Netter's Concise Atlas of Orthopaedic Anatomy, Frank H. Netter, John A. Craig, Frank H. Netter, John A. Craig, ICOH
Physical Examination of the Spine & Extremities. Stanley Hoppenfeld.Prentice Hall. Copyright 1976

TAG

(OBQ10-117) A 42-year-old female sustains the injury shown in Figure A. What other anatomic structure is most commonly injured with this fracture?

FIGURES: A

1. Radial head
2. Ulnohumeral joint
3. Distal radioulnar joint
4. Ulnar styloid
5. Scapholunate ligament

PREFERRED RESPONSE >

Figure A shows a distal radial shaft fracture, which is often associated with a distal radioulnar joint (DRUJ) dislocation. This is termed a Galeazzi fracture. This patient's AP radiograph is shown in illustration A, revealing an obvious DRUJ dislocation. Treatment of this unstable injury is operative, consisting of open reduction and internal fixation with a plate and screw construct, followed by intraoperative assessment of DRUJ alignment. The referenced study by Giannoulis et al is an excellent review of Galeazzi fractures and treatment methods.

Illustrations: A

References:

1) 2010 Orthopaedic In-Training Examination, Question #117. American Academy of Orthopaedic Surgeons, Rosemont IL.

2) Coeh MS, Jupiter JB. Fracture of distal radius. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, Krettek C, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction, 4th ed. Philadelphia, PA: WB Saunders; 2009:1459-1502.

3) Giannoulis FS, Sotereanos DG. Galeazzi fractures and dislocations. Hand Clin. 2007 May;23(2):153-63, v. PMID:17548007 (Link to Abstract)

Question Authors:

Ben Taylor MD,

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TAG

(OBQ07-47) A 30-year-old female presents with the injury shown in Figure A after falling on her outstretched arm. During operative treatment of the fracture, anatomic reduction of the radius is achieved. However, the surgeon is unable to reduce the distal radioulnar joint. What structure is most likely impeding the reduction?

FIGURES: A

1. Median nerve
2. Flexor carpi radialis
3. Pronator quadratus
4. Extensor carpi ulnaris
5. Flexor carpi ulnaris

PREFERRED RESPONSE >

Figure A shows a Galeazzi fracture (distal 1/3 radial shaft fracture with associated distal radioulnar joint dislocation). In this injury, an inability to reduce the distal radioulnar joint in a closed fashion is most commonly secondary to interposition of the extensor carpi ulnaris tendon. Early recognition of the dislocation of the ulna and ECU into the DRUJ and their significance may avoid poor results. The referenced study by Biyani et al reports a case in which both the extensor carpi ulnaris and extensor digiti minimi tendons were displaced on either side of the ulnar head. The referenced study by Budgen et al presents a case of a Galeazzi fracture dislocation with an irreducible distal radioulnar joint. The referenced study by Paley et al reports two cases of distal radioulnar joint (DRUJ) disruption and diastasis secondary to distal radial fractures that were associated with displacement of the ulnar styloid and extensor carpi ulnaris (ECU) into the DRUJ. Both cases had a palpable empty ECU tendon sulcus.

References:

1) 2007 Orthopaedic In-Training Examination, Question #47. American Academy of Orthopaedic Surgeons, Rosemont IL.

2) Biyani A, Bhan S: Dual extensor tendon entrapment in Galeazzi fracture-dislocation: A case report. J Trauma 1989;29:1295-1297. PMID:2769817 (Link to Abstract)

3) Budgen A, Lim P, Templeton P, Irwin LR. Irreducible Galeazzi injury. Arch Orthop Trauma Surg. 1998;118(3):176-8. PMID:9932197 (Link to Abstract)

4) Paley D, McMurtry RY, Murray JF. Dorsal dislocation of the ulnar styloid and extensor carpi ulnaris tendon into the distal radioulnar joint: The empty sulcus sign. J Hand Surg Am 1987;12:1029-1032. PMID:3693829 (Link to Abstract)

Question Authors:

Ben Taylor MD, Jan Szatkowski MD,

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Groups	Images	Category	Posted	Comments
ABOS II: Galeazzi Fractures		Oral Boards Review	07/29/11	0

Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions, Personal Observations, and Biomechanic Studies)

Giannoulis FS, Sotereanos DG. Galeazzi fractures and dislocations. Hand Clin. 2007 May;23(2):153-63, v. PMID:17548007 (Link to Abstract)
Biyani A, Bhan S: Dual extensor tendon entrapment in Galeazzi fracture-dislocation: A case report. J Trauma 1989;29:1295-1297. PMID:2769817 (Link to Abstract)
Budgen A, Lim P, Templeton P, Irwin LR. Irreducible Galeazzi injury. Arch Orthop Trauma Surg. 1998;118(3):176-8. PMID:9932197 (Link to Abstract)
Paley D, McMurtry RY, Murray JF. Dorsal dislocation of the ulnar styloid and extensor carpi ulnaris tendon into the distal radioulnar joint: The empty sulcus sign. J Hand Surg Am 1987;12:1029-1032. PMID:3693829 (Link to Abstract)

Textbooks

Review of Orthopaedics, 5th Edition, Mark D. Miller (editor), Saunders, an imprint of Elsevier, Philadelphia, Copyright 2008
First Aid for the Orthopaedic Boards, Robert Laminzak, Mark Albritton, Trevor Pickering (Editors), McGraw Hill Medical, Copyright 2009
Orthopaedic Knowledge Update 9, Jeffrey S Fischgrund (Editor). Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2008
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
OITE Questions, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2010
Frank H. Netter, John A. Craig. Netter's Concise Atlas of Orthopaedic Anatomy, Icon Learning Systems, Teterboro, NJ, Copyright 2002
Coeh MS, Jupiter JB. Fracture of distal radius. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, Krettek C, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction, 4th ed. Philadelphia, PA: WB Saunders; 2009:1459-1502.

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