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Updated: Apr 26 2022

Galeazzi Fractures

Images - AP and Lat - Galeazzi fx_moved.jpg fracture orif.jpg
  • Summary
    • A galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury.
    • Diagnosis can be suspected with a distal radius fracture with widening of the radioulnar joint on AP wrist radiographs and volar/dorsal subluxation of the radioulnar joint on lateral wrist radiographs.
    • Treatment is generally ORIF of the distal radius followed by assessing the stability of the DRUJ which may be warrant subsequent immobilization, DRUJ pinning or ORIF of the DRUJ.
  • Epidemiology
    • Incidence of DRUJ instability
      • if radial fracture is <7.5 cm from articular surface
        • unstable in 55%
      • if radial fracture is >7.5 cm from articular surface
        • unstable in 6%
  • Etiology
    • Mechanism
      • direct wrist trauma
        • typically dorsolateral aspect
      • fall onto outstretched hand with forearm in pronation
  • Anatomy
    • DRUJ
      • sigmoid notch
        • found along ulnar border of distal radius
        • is a shallow concavity for the articulating ulnar head
      • volar and dorsal radioulnar ligaments
        • function as the primary stabilizers of the DRUJ
      • most stable in supination
  • Classification
    • OTA classification of radius/ulna
      • OTA classification of radius/ulna
      • 22-A2.3
      • Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ
      • 22-A3.3
      • Radius/ulna, diaphyseal, simple fracture of both bones (distal zone radius) with dislocation of DRUJ
      • 22-B2.3
      • Radius/ulna, diaphyseal, wedge fracture of radius with dislocation of DRUJ
      • 22-B3.3
      • Radius/ulna, diaphyseal, wedge of both bones with dislocation of DRUJ
  • Presentation
    • Symptoms
      • pain, swelling, deformity
    • Physical exam
      • point tenderness over fracture site
      • ROM
        • test forearm supination and pronation for instability
      • DRUJ stress
        • causes wrist or midline forearm pain
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral views of forearm, elbow, and wrist
      • findings
        • signs of DRUJ injury
          • ulnar styloid fx
          • widening of joint on AP view
          • dorsal or volar displacement on lateral view
          • radial shortening (≥5mm)
  • Treatment
    • Operative
      • ORIF of radius with reduction and stabilization of DRUJ
        • indications
          • all cases, as anatomic reduction of DRUJ is required
          • acute operative treatment far superior to late reconstruction
  • Techniques
    • ORIF of radius
      • approach
        • volar (Henry) approach to radius
      • plate fixation
        • perform anatomic plate fixation of radial shaft
        • radial bow must be restored/maintained
    • Reduction & stabilization of DRUJ
      • approach
        • dorsal capsulotomy
      • reduction technique
        • immobilization in supination (6 weeks)
          • indicated if DRUJ stable following ORIF of radius
        • percutaneous pin fixation
          • indicated if DRUJ reducible but unstable following ORIF of radius
          • cross-pin ulna to radius
            • leave pins in place for 4-6 weeks
        • open surgical reduction
          • indicated if reduction is blocked
            • suspect interposition of ECU tendon
        • open reduction internal fixation
          • indicated if a large ulnar styloid fragment exists
          • fix styloid and immobilize in supination
  • Complications
    • Compartment syndrome
      • increased risk with
        • high energy crush injury
        • open fractures
        • vascular injuries or coagulopathies
      • diagnosis
        • pain with passive stretch is most sensitive
    • Neurovascular injury
      • uncommon except type III open fractures
    • Refracture
      • usually occurs following plate removal
      • increased risk with
        • removing plate too early
        • large plates (4.5mm)
        • comminuted fractures
        • persistent radiographic lucency
      • prevention
        • do not remove plates before 18 months after insertion
          • amount of time needed for complete primary bone healing
    • Nonunion
    • Malunion
    • DRUJ subluxation
      • displaced by gravity, pronator quadratus, or brachioradialis
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