Galeazzi Fracture Dislocation: Clinical Features, Treatment and Complications

Galeazzi fracture dislocation is a fracture of the middle to distal radius associated with a subluxation or dislocation of the distal radioulnar joint

Galeazzi fractures are much more common than Monteggia fractures, Galeazzi account for 7% of all forearm fractures in adults

Radius fractures occurring closer to the wrist are associated with greater instability of the DRUJ

Mechanism of injury

Caused by a fall on the outstretched hand with extended wrist and pronated forearm and a rotational force applied to the body

They also could occur from sports injuries and motor vehicle accidents

Clinical features

Symptoms

Patient present with pain in the forearm and wrist

Physical examination

Look

Look for Swelling, contusions and lacerations

Deformity of the radius or wrist might be obvious

Inspect the lacerations for any evidence of open fracture

Feel

Feel for tenderness over the forearm and wrist

Neurovascular examination is done to look for nerve/vessel injury (esp. median and radial nerves), inquire about weakness, numbness, paresthesia and motor examination

Move

Patient refuse movement due to pain

Examination is repeated multiple times to exclude compartment syndrome

Imaging

X-ray radiographs (forearm AP and lateral) should be ordered and they are enough for diagnosis

A transverse or oblique fracture is seen in the radius with angulation or shortening,

DRUJ is disrupted, signs include:

AP and lateral forearm X-rays showing Galeazzi fracture dislocation; by Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons

AP and lateral forearm X-rays showing Galeazzi fracture dislocation; by Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons

Note

The distal radioulnar joint could be injured with isolated radial fracture at any level, or in both forearm bones fractures

Emergency management

Pain management

Gross forearm deformity should be reduced in the emergency department under procedural sedation

Above elbow backslab is applied to support the fracture and prevent rotation

Reassessment of neurovascular status is done

Definitive management

Same as Monteggia, it is important to restore the length of the broken bone

In children, closed reduction is often successful, but in adults closed reduction lead to poor outcomes

That is why in adults, reduction is best achieved by ORIF and plating of the radius and the DRUJ is re examined and re imaged to ensure it is reduced

If the DRUJ is reduced and stable on full range of movement, no further management is needed

If the DRUJ is reduced but unstable then the forearm should be immobilized in the position of stability for the DRUJ (usually supination); K wires maybe applied to support the joint

If the DRUJ is irreducible by closed reduction then open reduction is needed to remove soft tissue interposition or fracture fragment preventing reduction; the triangular fibrocartilage complex and dorsal capsule are then carefully repaired, if there is associated ulnar styloid fracture then it has to be repaired by ORIF

After reduction in all cases, above elbow casting in supination is done for 6 weeks , exercises started as soon as possible

Complications

Early

Late

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