It is the result of forceful axial loading of the maximally pronated forearm while the wrist is in extension. Galeazzi fracture-dislocation may occur during a fall and less frequently during motor vehicle accidents, electric shock, or blunt trauma. The term Galeazzi-equivalent lesion was introduced in 1982 to describe a fracture of the distal radius in association with a fracture of the distal pole of the ulna in adults or separation of distal ulnar epiphysis without DRUJ disruption in children. 2 It is also known as reverse Monteggia fracture, Piedmond fracture, or Darrach–Hughston–Milch fracture, while the term “fracture of necessity” is also frequently used to describe this inherently unstable injury that requires surgical treatment to achieve favorable outcomes, particularly in adults. 1 However, this injury has become connected with the name of Ricardo Galeazzi who in 1934 reported his experience with 18 such cases. Misdiagnosis or inappropriate treatment will result in persistent DRUJ instability and wrist pain, as well as decreased grip strength and forearm rotation.Īsley Cooper was the first to describe a distal radial shaft fracture with disruption of the DRUJ in 1824. However, the true incidence remains unknown because Galeazzi lesions are frequently underdiagnosed. DRUJ involvement is the unique feature of this type of injury, which accounts for nearly 7% of all fractures of the forearm in adults and nearly 3% in children. Lykissasįracture of the shaft of the radius complicated by dislocation or subluxation of the distal radioulnar joint (DRUJ) is commonly referred to as Galeazzi fracture-dislocation. In Galeazzi-equivalent fractures, ulnar physeal arrest is frequent, seen in 55% of cases.Anastasios V. distal radioulnar joint now stable: immobilization in supination in an above-elbow cast is indicated 7.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.irreducible: further exploration of the distal radioulnar joint with the view to release interposition and post-release re-assessment of the distal radioulnar joint:.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.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 stable: splint and early motion 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.įollowing intraoperative assessment of the distal radioulnar joint, the reducibility and stability of the joint determines the indicated treatment: 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. 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: asymmetry of the distal radioulnar joint when compared to the other forearm 6. widening of the distal radioulnar joint on the frontal view 6.radial shortening may occur, and if greater than 10 mm, suggests complete disruption of the interosseous membrane.dislocation of the distal radioulnar joint.commonly at the junction of the middle and distal thirds.However, good quality orthogonal views are needed to identify and characterize displacement correctly. Galeazzi fractures are classified according to the direction of radial displacement:Ī forearm series is usually sufficient for diagnosis and management planning. 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 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.
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