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 login to view 4 more bullets Treatment Operative ORIF of radius with reduction and stabilization of DRUJ indications login to view 2 more bullets 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) login to view 1 more bullet percutaneous pin fixation login to view 3 more bullets open surgical reduction login to view 2 more bullets open reduction internal fixation login to view 2 more bullets 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 login to view 1 more bullet Nonunion Malunion DRUJ subluxation displaced by gravity, pronator quadratus, or brachioradialis