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Updated: Dec 28 2021

Galeazzi Fracture

  • 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
          • distal radioulnar joint (DRUJ)
            • between distal radius and distal ulna
            • stabilized by the volar and dorsal radioulnar ligaments
          • radiocarpal joint
            • between distal radius and proximal carpal row
          • intercarpal joint
            • between proximal and distal carpal rows
      • fracture anatomy
        • distal radius fracture can be associated with DRUJ disruption depending on the distance of fracture from the radial articular surface
          • if a radial fracture is < 7.5 cm from the articular surface
            • unstable in 55%
          • if a radial fracture is >7.5 cm from the articular surface
            • unstable in 6%
        • primary deforming forces
          • brachioradialis
            • pulls the distal radial fragment radially
          • pronator quadratus
            • rotates the distal radial fragment ulnarly
          • weight of the hand
            • dorsally angulates the radius
    • 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
          • always important to obtain imaging of the joint above and below the suspected area of injury
      • finding
        • fracture of the distal radius
        • dislocation of the DRUJ
  • Differential
    • Monteggia fracture
      • distinguishing factors
        • Monteggia fracture is characterized by two different bony injuries
          • proximal ulna fracture
          • radial head dislocation
    • 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
          • unstable DRUJ
            • Galeazzi fracture-dislocation
          • stable DRUJ
            • isolated distal radius fracture
  • Treatment
    • Nonoperative
      • closed reduction and casting
        • indications
          • pediatric patients
    • Operative
      • open reduction and internal fixation
        • indications
          • adult patients
  • 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
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