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Perform closed reduction of the radius, then immobilize the forearm in a long arm cast in supination.
1%
52/6311
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.
5%
288/6311
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.
4%
229/6311
Perform closed reduction of the radius, then assess the distal radioulnar joint for instability, and perform internal fixation of the radius if instability persists.
3%
205/6311
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.
87%
5490/6311
Select Answer to see Preferred Response
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. Incorrect Answers: 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.
4.8
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