summary Galeazzi Fractures are rare injuries in the pediatric population and consist of distal radius fractures at the distal metaphyseal-diaphyseal junction with concomitant disruption of the distal radioulnar joint. Diagnosis is made with plain radiographs. Treatment is generally closed reduction and casting for the majority of fractures. Surgical management is indicated for irreducible DRUJ due to interposed tendon or periosteum. Epidemiology Incidence relatively rare injury (3% of distal radius fractures associated with DRUJ disruption) less frequent than in adults often missed injury pattern (up to 41%) when radial fracture is < 7.5 cm from the articular surface, 55% chance of DRUJ instability (6% chance if > 7.5 cm) Demographics peak incidence 9 to 13 years old Etiology Pathophysiology DRUJ disruption disruption of the DRUJ in a pediatric patient can consist of login to view 3 more bullets pathoanatomy axial loading in combination with extremes of forearm rotation (pronation or supination) login to view 2 more bullets Associated injuries nerve injuries are rare Anatomy DRUJ osteology possesses poor bony conformity in order to allow some translation with rotatory movements ligamentous ligament structures are critical in stabilizing the radius as it rotates about the ulna during pronation and supination triangular fibrocartilage complex (TFCC) is a critical component to DRUJ stability biomechanics the joint is most stable at the extremes of rotation Classification Walsh classification Type I Dorsal displacement of the radius Due to supination force Type II Volar displacement of the radius Due to pronation force Presentation Symptoms wrist and forearm pain radial deformity limitation of wrist motion ulnar head prominence or deformity can sometimes be seen Physical exam pain with movement or palpation of the wrist DRUJ instability may be appreciated by local tenderness and instability to testing of the DRUJ compare to contralateral side careful examination for nerve injury Imaging Radiographs required views AP and true lateral radiographs login to view 3 more bullets additional views contralateral radiographs often helpful for comparison findings displaced distal radial shaft fracture DRUJ disruption login to view 5 more bullets Treatment Nonoperative closed reduction with long arm casting indications login to view 2 more bullets reduction login to view 3 more bullets immobilization login to view 1 more bullet outcomes login to view 1 more bullet Operative open reduction internal fixation +/- DRUJ pinning indications login to view 2 more bullets technique login to view 1 more bullet ORIF, soft tissue reconstruction of DRUJ and TFCC, +/- corrective osteotomy indications login to view 1 more bullet corrective osteotomy with soft tissue reconstruction of DRUJ and TFCC indications login to view 2 more bullets Technique ORIF with volar plating, +/- DRUJ pinning approach dorsal approach to DRUJ to remove interposed material (ECU) if unable to obtain closed reduction volar approach for ORIF(with plate) open reduction irreducible DRUJ requires an open reduction to remove interposed material reduction can be blocked by interposed login to view 3 more bullets DRUJ stability following fixation, test DRUJ (shuck test) login to view 2 more bullets ORIF with flexible intramedullary nailing, +/- DRUJ pinning approach percutaneous (with IMN) of radius fracture open reduction same as above DRUJ stability same as above Complications Delayed diagnosis Malunion/nonunion of the radius commonly a result of persistent ulnar subluxation Chronic DRUJ instability chronic DRUJ instability (a rare consequence of a missed injury) less common in children Acute carpal tunnel syndrome Superficial radial nerve palsy can be seen with IMN Ulnar nerve injury Stiffness limited pronosupination Extensor pollicis longus rupture Ulnar physeal arrest 55% incidence in Galeazzi-equivalent fractures