Galeazzi Fracture
Dislocation
Presenter: Dr Ramin Maharjan
First year Resident, Orthopaedics, PAHS
Moderator: Assistant Prof Dr Bidur Gyawali
Contents
• Introduction
• History
• Relevant Anatomy
• Etiology
• Epidemiology
• Classification
• Presentation
• Treatment
• Complications
Introduction – Galeazzi fracture dislocation
• The combination of fracture of the middle to distal third of the radius
associated with dislocation or subluxation of the distal radioulnar
joint (DRUJ).
• counterpart of the Monteggia fracture-dislocation
• also known as a reverse Monteggia fracture.
History
• first described by Sir Astley Cooper
in 1822
• Ricardo Galeazzi (1866-1952) in 1934
• an Italian surgeon in Milan, he reported
on his experience with 18 fractures
with mechanism, incidence and
management of this injury.
• In 1941, Campbell termed the "fracture
of necessity," necessitates surgical
treatment
• Hughston outlined the definitive
management in 1957
Relevant Anatomy
DRUJ
•Radial sigmoid notch and articulating ulnar head
•Stabilizers:
• Bony articulation
• Soft tissue
• Static
• TFCC
• volar and dorsal radioulnar ligaments
-function as the primary stabilizers of the
DRUJ
• IOM
• Dynamic
• ECU
• PQ
•most stable in supination
TFCC
• TFC
• Ulnar collateral ligament
• Ulnotriquetral
• ulnolunate
Forearm as a joint
• Quadrilateral joint
• One functional unit
Deforming force
Radius rotates around the ulna
• Pronation
– Ulnar head dorsal
– DRUL taut
– If PRUL ruptures, dislocates dorsally
• Supination
– Ulnar head volar
– PRUL taut
– If DRUL ruptures, dislocates volarly
Axial Load transmission
20%
U
80%
R
40% 60%
U R
Halls 1964, Palmer 1984, Birkbeck 1997
Etiology
• Indirect trauma :- due to a fall on an outstretched hand with an extended
wrist and superimposed rotation force
• Rotation determines direction of angulation
– Pronation flexion injury ( dorsal angulation )
– Supination extension injury (volar angulation)
• Direct trauma :- to the wrist, typically on the dorsolateral aspect
Epidemiology
• Approximately 7% of all forearm fractures in adults.
• One in four radial shaft fractures is a true Galeazzi injuries.
• Bimodal distribution
• Young males - high-energy trauma (e.g., Sports injuries, falls from height, motor vehicle
collisions)
• Aging females - low-energy traumas such as falls from ground level
Types
Type I Type II
• apex volar • apex dorsal
• Caused by axial loading of forearm in • fractures are caused by axial
supination loading of forearm in pronation
• dorsal displacement of radius and • anterior displacement of radius and
volar dislocation of distal ulna dorsal dislocation of distal ulna
Rettig ME and Raskin KB classification
based on fracture stability
Type I Type II
• Fracture occurring distally from • Fracture occurring proximally
the 7.5 cm demarcation (i.e., from the 7.5 cm demarcation
closer to the wrist) (i.e., further from the wrist)
• Associated with significant • Associated with significant
DRUJ instability in more than DRUJ instability in only around
50% of cases 5% of cases
*stability to be dependent on the distance of the radial fracture from the distal radial articular surface.
Presentation
•History : fall on out stretched hand
•Symptoms :
– Pain and swelling in forearm and wrist
– Painful forearm rotation
•Signs
• Prominence or tenderness over the lower end of ulna
• Evaluate for compartment syndrome
• NV exam : radial nerve or median nerve
Associated Injuries
• Ulnar Styloid Fracture
• Anterior interosseous nerve (AIN) palsy
• TFCC injury
• DRUJ instability
• ulnar styloid fracture
• widening of joint on AP view
• dorsal or volar displacement on lateral view
• radial shortening (≥5mm)
Anterior interosseous nerve palsy
TFCC
injury
Distal Radio-ulnar joint
instability
Stress test/ Ballotment test Piano key test
Imaging
• Plain radiograph
• 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)
• CT scan - evaluate for non-union, and
• MRI - evaluate for TFCC tears and interosseous membrane disruption.
X- RAY forearm and
wrist A-P view Lateral
view
signs of DRUJ injury
• Ulnar styloid fracture
• Widening of the joint on AP view
• Dorsal or volar displacement on lateral
view
• Radial shortening (>5mm)
Management
Principle
• In children, closed reduction is often successful
• in adults, reduction is best achieved by open reduction and internal
fixation with 3.5mm AO dynamic compression plating of the radius
• important step is to restore the length of the fractured bone and
ensure DRUJ stability
• acute operative treatment far superior to late reconstruction
Approach
•Two approaches
• Henry
• Volar
• Good for middle to distal third fractures
• Thompson
• Dorsal
• Good for proximal to middle third fractures
3 possibilities of DRUJ
Reduced Reduced but
Irreducible
and stable unstable Open reduction
is needed to
remove the
Temporarily interposed soft
transfixed with two tissues.
K wires with
forearm in
TFCC and dorsal
Splinted in supination
capsule carefully
repaired
supination, Removed after 6
for 6 weeks and active Forearm immobilized
weeks forearm rotation in supination
is begun. supported by a wire if
needed for 6 weeks
Post operative care
• Check neurologic and vascular status
– Specifically, evaluate for function of the anterior interosseous nerve
(AIN)
– presence of compartment syndrome
• Immobilize the forearm in supination for 6 weeks
• obtain radiographs to recheck alignment and reduction of the
radius and the DRUJ
Post operative care
• Removal of any percutaneous pins at 4-6 weeks
• Recheck radiographs to confirm maintenance of reduction, and
replace the cast brace in supination
• Institute physiotherapy for elbow, digital and shoulder range of
motion
• Reexamine radiographs at 6-week intervals until healing is
apparent.
Complication
• Compartment syndrome • prevention
• do not remove plates before 18
• Neurovascular injury months after insertion
• uncommon except type III open • amount of time needed for complete
fractures primary bone healing
• Refracture • Nonunion
• usually occurs following plate • Malunion
removal
• increased risk with
• DRUJ subluxation
• removing plate too early • displaced by gravity, pronator
• large plates (4.5mm) quadratus, or brachioradialis
• comminuted fractures
Algorith
m
Conclusion
• A galeazzi fracture is a distal 1/3 radial shaft fracture with
an associated distal radioulnar joint (DRUJ) injury.
• Often go untreated
• fracture of necessity
References
1. Rockwood and Green’s- Fractures in adults – 9th Edition
2. Campbell’s Operative orthopaedics – 14th edition
3. Apley & Solomon's system of orthopaedics and trauma
4. Orthobullet
5. Johnson NP, Smolensky A. Galeazzi Fractures. [Updated 2020
Jul 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470188/
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