Snapshot A 22-year-old man presents to the emergency room with severe left arm pain. 1 hour prior to presentation, he was climbing a tree to retrieve a radio-controlled aircraft and fell 6 feet onto the ground. He landed on his pronated outstretched left arm and developed immediate-onset pain and swelling. On exam, he is tender to palpation with a notable deformity characterized by radial wrist angulation. The distal ulna is palpable. Radiographs demonstrate a fracture of the distal radial diaphysis with associated dislocation of the distal radioulnar joint. Introduction Clinical definition traumatic injury to the distal forearm characterized by the presence of two bony injuries diaphyseal fracture of the distal radius distal radioulnar joint (DRUJ) dislocation given the presence of a fracture and dislocation, these injuries are sometimes referred to as Galeazzi fracture-dislocations Epidemiology Incidence 3-7% of forearm fractures Demographics males more likely than females Etiology Traumatic injury direct blow to the dorsolateral forearm Fall On an OutStretched Hand (FOOSH) falling on a pronated forearm Pathoanatomy normal anatomy of the wrist wrist consists of 3 bony articulations login to view 7 more bullets fracture anatomy distal radius fracture can be associated with DRUJ disruption depending on the distance of fracture from the radial articular surface login to view 4 more bullets primary deforming forces login to view 6 more bullets Associated conditions anterior interosseous nerve (AIN) palsy compartment syndrome ulnar styloid fracture indicator of DRUJ injury Presentation Symptoms wrist pain swelling Physical exam deformity may be noted depending on fracture severity pain with wrist flexion/extension and forearm pronation/supination must assess for DRUJ instability Imaging Radiography indication radiographs are indicated in any forearm injury in which a fracture is suspected anteroposterior (AP) and lateral views of the wrist, forearm, and elbow are required login to view 1 more bullet finding fracture of the distal radius dislocation of the DRUJ Differential Monteggia fracture distinguishing factors Monteggia fracture is characterized by two different bony injuries login to view 2 more bullets Distal radius fracture distinguishing factors in an isolated distal radius fracture, DRUJ will be stable any patient with a distal radius fracture should be assessed for DRUJ instability login to view 4 more bullets Treatment Nonoperative closed reduction and casting indications login to view 1 more bullet Operative open reduction and internal fixation indications login to view 1 more bullet Complications AIN palsy AIN innervates the flexor pollicis longus (FPL) and flexor digitorum longus (FDP) on exam, will demonstrate loss of pinch between thumb and index finger Compartment syndrome Prognosis Unfavorable loss of reduction