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Galeazzi fracture-dislocations consist of a fracture of the distal part of the radius with disruption of the distal radioulnar joint. A Galeazzi-equivalent fracture is a distal radial fracture with a distal ulnar physeal fracture 2.
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Galeazzi fractures are primarily encountered in children, with a peak incidence at age 9-12 years 3. In adults, it is estimated to account for ~7% of forearm fractures 3.
Typically, Galeazzi fracture-dislocations occur due to a fall on an outstretched hand (FOOSH) and result in dorsal displacement of the radius (type I) if the axial load was applied to the forearm in supination or volar displacement of the radius (type II) if the forearm was in pronation 7.
Galeazzi fractures are classified according to the direction of radial displacement:
- type I: dorsal displacement
- type II: volar displacement
A forearm series is usually sufficient for diagnosis and management planning. However, good quality orthogonal views are needed to identify and characterize displacement correctly. Features include:
- radial shaft fracture
- commonly at the junction of the middle and distal thirds
- dorsal angulation
- dislocation of the distal radioulnar joint
- radial shortening may occur, and if greater than 10 mm, suggests complete disruption of the interosseous membrane
- base of ulnar styloid fracture 5,6
- widening of the distal radioulnar joint on the frontal view 6
- asymmetry of the distal radioulnar joint when compared to the other forearm 6
In addition to stating the presence of the radial fracture and distal radioulnar joint dislocation, a number of features should be sought and commented on:
- radial fracture
- the degree of shortening (see above)
- distal radioulnar joint dislocation
Treatment and prognosis
Galeazzi fracture-dislocations are unstable requiring surgical intervention, which involves open reduction and internal fixation (ORIF) of the radial fracture, intraoperative assessment of the distal radioulnar joint for reducibility and stability, and subsequent Kirschner wire fixation of the ulna to the radius, triangular fibrocartilage complex (TFCC) exploration and repair, and splinting or immobilization in supination via an above-elbow cast 7.
Open reduction of the radial shaft fracture and internal fixation with a dynamic compression plate and screws may also reduce the distal radioulnar joint dislocation 7.
Following intraoperative assessment of the distal radioulnar joint, the reducibility and stability of the joint determines the indicated treatment:
- reduced and stable: splint and early motion 7
- reduced and unstable with no ulnar styloid fragment: Kirschner wire fixation of the ulna to the radius, triangular fibrocartilage complex exploration and repair if necessary and immobilization in supination in an above-elbow cast 7
- reduced and unstable with large ulnar styloid fragment: open reduction and internal fixation of the ulnar styloid followed by immobilization in an above-elbow cast 7
- irreducible: further exploration of the distal radioulnar joint with the view to release interposition and post-release re-assessment of the distal radioulnar joint:
- distal radioulnar joint remains unstable: by triangular fibrocartilage complex exploration and repair followed by Kirschner wire fixation of the ulna to radius and immobilized in supination in an above-elbow cast
- distal radioulnar joint now stable: immobilization in supination in an above-elbow cast is indicated 7
In Galeazzi-equivalent fractures, ulnar physeal arrest is frequent, seen in 55% of cases.
History and etymology
First described in 1934 by Italian orthopedic surgeon Riccardo Galeazzi (1866-1952) 1,2.
Many people consider the Galeazzi and Piedmont fractures as the same injury. However, some state that the latter is an isolated radial fracture without distal radioulnar dissociation. The Piedmont fracture was so named by the Piedmont Orthopedic Society.
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