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 login to view 2 more bullets 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) login to view 1 more bullet Pathoanatomy normal anatomy of the wrist login to view 8 more bullets fracture anatomy login to view 12 more bullets Associated conditions anterior interosseous nerve (AIN) palsy compartment syndrome ulnar styloid fracture login to view 1 more bullet 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 login to view 3 more bullets finding login to view 2 more bullets Differential Monteggia fracture distinguishing factors login to view 3 more bullets Distal radius fracture distinguishing factors login to view 6 more bullets Treatment Nonoperative closed reduction and casting login to view 2 more bullets Operative open reduction and internal fixation login to view 2 more bullets 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