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
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next (OBQ12.147) 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: QID: 4507 FIGURES: A B Type & Select Correct Answer 1 Perform closed reduction of the radius, then immobilize the forearm in a long arm cast in supination. 1% (51/5901) 2 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. 4% (261/5901) 3 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% (209/5901) 4 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% (193/5901) 5 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% (5146/5901) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ10.117) A 42-year-old female sustains the injury shown in Figure A. What other anatomic structure is most commonly injured with this fracture? QID: 3211 FIGURES: A Type & Select Correct Answer 1 Volar long radiolunate ligament 3% (156/5903) 2 Radioscaphocapitate ligament 3% (166/5903) 3 Dorsal radioulnar ligaments 90% (5313/5903) 4 Ligament of Testut and Kuentz 1% (86/5903) 5 Scapholunate ligament 3% (149/5903) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.47) 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? QID: 708 FIGURES: A Type & Select Correct Answer 1 Median nerve 1% (10/1370) 2 Flexor carpi radialis 6% (81/1370) 3 Pronator quadratus 38% (516/1370) 4 Extensor carpi ulnaris 48% (651/1370) 5 Flexor carpi ulnaris 8% (106/1370) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (SBQ06TR.84) Which of the following injuries would require plating of the radius along with closed reduction and evaluation of the distal radioulnar joint (DRUJ)? QID: 2696 Type & Select Correct Answer 1 Nightstick fracture 0% (4/1641) 2 Galeazzi fracture 95% (1559/1641) 3 Monteggia fracture 3% (46/1641) 4 Rolando fracture 0% (5/1641) 5 Smith fracture 1% (13/1641) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos Cleveland Combined Hand Fellowship Lecture Series 2020-2021 Polytrauma: Case of the Week - Shaan Patel, MD Shaan S. Patel Trauma - Galeazzi Fractures E 5/19/2021 116 views 4.0 (1) Login to View Community Videos Login to View Community Videos Galeazzi Fracture - Everything You Need To Know - Dr. Nabil Ebraheim Nabil Ebraheim (PD) Trauma - Galeazzi Fractures D 8/28/2012 1865 views 5.0 (4) Trauma⎪Galeazzi Fractures Orthobullets Team Trauma - Galeazzi Fractures Listen Now 15:53 min 1/14/2020 780 plays 4.9 (8)
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