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Average 4.1 of 53 Ratings
A 33-year-old man sustains blunt trauma to his forearm and presents with the injury seen in Fig A and B. Definitive management of this injury involves the following:
Perform closed reduction of the radius, then immobilize the forearm in a long arm cast in supination.
Perform open reduction and internal fixation of the radius, then assess the proximal radioulnar joint for instability, and percutaneously fix the proximal radioulnar joint if instability persists.
Perform open reduction and internal fixation of the radius, then assess the distal radioulnar joint for instability, and reconstruct the distal radioulnar joint with a looped palmaris longus autograft if instability persists.
Perform closed reduction of the radius, then assess the distal radioulnar joint for instability, and perform internal fixation of the radius if instability persists.
Perform open reduction and internal fixation of the radius, then assess the distal radioulnar joint for instability, and percutaneously fix the distal radioulnar joint if instability persists.
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Galeazzi fracture-dislocations are fractures of necessity and must be managed surgically. The first step involves surgical fixation of the radial fracture. Next, the distal radioulnar joint (DRUJ) needs to be assessed for stability by looking for gross motion of the distal ulna in forearm supination. If DRUJ instability persists, this needs to be addressed with temporary percutaneous pin fixation with one or two 1.2- or 1.6mm K-wires placed transversely proximal to the sigmoid notch. This is followed by immobilization in above-elbow plaster casts in forearm supination for 6 weeks postop. Anatomic reduction and rigid fixation of the radius alone does not guarantee DRUJ stability.
Rettig et al. found that the anatomical location of the radial shaft fracture could be used to predict DRUJ instability. Fractures within 7.5cm of the midarticular surface of the distal radius were more likely to require K wire stabilization (55%) compared with fractures more than 7.5cm away (6%).
Korompilias et al. found fractures of the distal third were more likely to require DRUJ stabilization (54%) than fractures of the middle third (12%) and proximal third (11%).
Giannoulis et al., in a review of Galeazzi fracture-dislocations, summarized the options as follows: (1) Stable DRUJ, cast in supination for 6 weeks; (2) Unstable DRUJ, TFCC repair and DRUJ pinning with a K wire in neutral rotation; (3) Unstable DRUJ with ulnar styloid fracture, ORIF of ulnar styloid with tension band wire or lag screw; (4) Irreducible DRUJ because of tendon interposition (ECU, EDC or EDM), open reduction and TFCC repair.
Figures A and B are AP and lateral radiographs demonstrating a Galeazzi fracture-dislocation with marked disruption of the DRUJ. The radial head is visible in both radiographs and is not dislocated.
Answer 1: The radius fracture requires surgical fixation. While casting in supination may reapproximate DRUJ alignment, only pinning can prevent future subluxation.
Answer 2: Dislocation of the radial head and proximal radioulnar joint instability is characteristic of Monteggia fracture-dislocations. In this injury complex, the proximal ulnar shaft is fractured and not the radius. Galeazzi fracture-dislocations must not be confused with a Monteggia fracture-dislocation.
Answer 3: Tendon graft stabilization is an option for chronic DRUJ instability.
Answer 4: The radial fracture must first be reduced and fixed with a plate. Assessment of DRUJ stability is only possible after rigid fixation of the radial fracture has been performed.
Rettig ME, Raskin KB
J Hand Surg Am. 2001 Mar;26(2):228-35. PMID: 11279568 (Link to Abstract)
Rettig, JHS 2001
Korompilias AV, Lykissas MG, Kostas-Agnantis IP, Beris AE, Soucacos PN
J Hand Surg Am. 2011 May;36(5):847-52. PMID: 21435802 (Link to Abstract)
Korompilias, JHS 2011
Giannoulis FS, Sotereanos DG.
Hand Clin. 2007 May;23(2):153-63, v. PMID: 17548007 (Link to Abstract)
Giannoulis, HANDC 2007
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Average 5.0 of 15 Ratings
A 42-year-old female sustains the injury shown in Figure A. What other anatomic structure is most commonly injured with this fracture?
Volar long radiolunate ligament
Dorsal radioulnar ligaments
Ligament of Testut and Kuentz
Figure A shows a fracture of the distal 1/3 of the radius. This fracture is often associated with dislocation of the distal radioulnar joint (DRUJ). When the two injuries are present together, it is commonly referred to as a Galeazzi fracture.
DRUJ instability is a result of injury to the volar and dorsal radioulnar ligaments which are the primary stabilizers of this joint. Imaging often shows widening of the DRUJ on AP view, dorsal or volar displacement on lateral view and radial shortening. Treatment of a Galeazzi injury is operative, consisting of open reduction and internal fixation of the radius 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.
Ward et al found in a cadaver study that the most significant increases in translation of the wrist occurred after sectioning the dorsal radioulnar ligament in pronation and after sectioning the palmar radioulnar ligament in supination.
This patient's AP radiograph is shown in illustration A, and this shows an obvious DRUJ dislocation.
Choice 1,2,4 and 5 are not associated with injury of the DRUJ
Ward LD, Ambrose CG, Masson MV, Levaro F
J Hand Surg Am. 2000 Mar;25(2):341-51. PMID: 10722827 (Link to Abstract)
Ward, JHS 2000
Grassmann JP, Hakimi M, Gehrmann SV, Betsch M, Kröpil P, Wild M, Windolf J, Jungbluth P
Bone Joint J. 2014 Oct;96-B(10):1385-91. PMID: 25274926 (Link to Abstract)
Grassmann, BJJ 2014
Average 4.0 of 23 Ratings
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?
Flexor carpi radialis
Extensor carpi ulnaris
Flexor carpi ulnaris
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.
Biyani A, Bhan S.
J Trauma. 1989 Sep;29(9):1295-7. PMID: 2769817 (Link to Abstract)
Biyani, JTACS 1989
Budgen A, Lim P, Templeton P, Irwin LR.
Arch Orthop Trauma Surg. 1998;118(3):176-8. PMID: 9932197 (Link to Abstract)
Budgen, AOTS 1998
Paley D, McMurtry RY, Murray JF.
J Hand Surg Am. 1987 Nov;12(6):1029-32. PMID: 3693829 (Link to Abstract)
Paley, JHS 1987
Average 4.0 of 43 Ratings
Educational video describing the condition known as Galeazzi Fracture.
HPI - Patient sustained galeazzi fracture right radius 8months back.he was operated but implant got infected and loose.About three months after initial surgery he was operated for implant removal and antibiotic impregnated cement was inserted .patient again developed reinfected one month after surgery and was advised redribedment again.but he did non report for surgery.
Now he has presented 2days back with increased deformity and infection
How would you treat this patient?
HPI - Patient sustained fracture about one year back .was operated for O/R&I/F with plates and screw through dorsal approach.After 3 months the patient presented with broken implant.he did not had any treatment for about 6 months .
Three months back he was again operated for nonunion .O/R&I/F with plates and screw was done with bone grafting.
About one week back patient again presented with broken implant and non union
What should be further treatment plan.
HPI - A 80-year-old male presented with a h/o fall with forearm fracture 40 days ago that was treated at an outside hospital with POP casting. He now presents with pain and deformity of the left (non-dominant) forearm.
What would be your next step in treatment for this patient?