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:
  • Widening of DRUJ on AP
  • Dorsal displacement of the ulna on the lateral view
  • Ulnar styloid fracture
  • Radial shortening greater than 5 mm

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
  • Vascular injury
  • Nerve injury
  • Compartment syndrome: especially in high energy injuries
  • Muscle tendon entrapment: make reduction difficult 
• Late
  • Malunion
  • Non union
  • Radioulnar synostosis
  • Elbow stiffness

Course Menu

This article is apart from The Elbow and Forearm Trauma Free Course; This course contains a number of lectures listed below: