Galeazzi's Fracture (Adults) : Wheeless' Textbook of Orthopaedics

Discussion

frx of radial shaft (between middle and distal 1/3's) & dislocation of distal radioulnar joint;
- usually the dislocation is dorsal, but in some cases can be palmar;
- frx is almost always located just above proximal border of pronator quadratus;
- usually there is anterior angulation w/ transverse or short oblique config;
  - ref: A Historical Report on Riccardo Galeazzi and the Management of Galeazzi Fractures
RU joint injury:
- may be purely ligamentous (tearing the TFCC)
- ligament complex may remain intact and the ulnar styloid may be avulsed
- in children there may be separation of the distal ulnar epiphysis
  - ref: Complex volar distal radioulnar joint dislocation occurring in a Galeazzi fracture.
mechanism: usually direct blows and falls;
- ref: Isolated Radial Shaft Fractures Are More Common Than Galeazzi Fractures.
displacing forces:
- wt of hand tends to cause subluxation of distal RU joint & dorsal angulation of the frx radius;
- insertion of pronator quadratus on palmar surface of distal fragment rotates it toward ulna & pulls it in prox & palmar direction;
- brachioradialis causes shortening & rotation of distal RU joint

see plating techniques:
adults tend to have poor results with closed reduction;
most adults require compression plates & screws (see below);
- w/ pure transverse frx, 4 hole 4.5 mm plate or 6 hole 3.5 mm plate is acceptable, but if there is comminution a larger plate is necessary;
- no screw should be w/ in 1 cm of frx;
- references:

following fixation of the radius, need to reevaluate distal RU joint;
it is often difficult to evaluate stability of the RU joint w/o opening and directly visualizing the joint;
the closer the radius fracture is to the DRUJ, the more likely it is to be unstable;
even if the supinated joint appears to reduce under flouro, the surgeon's fingers may palpate gross dorsal subluxation;
in the report by Rettig ME and Raskin KB, the authors categorized these fracture into type I (fractures within 7.5 cm of midarticular surface of the distal radius) and type II fractures (greater than 7.5 cm from joint surface);
- 22 fractures were type I, and 12 of these cases were associated with intraoperative DRUJ instability;
- 18 type II fractures and were type II, and only one of these frx had intraoperative DRUJ instability after ORIF;
surgical fixation:
- have the surgical assistant partially supinate the patient's arm
- the surgeon's non dominant hand keeps the joint reduced and helps to "triangulate the k wire" which is driven in with the surgeon's dominant hand;
if RU joint is unstable, then K wire fixation is required (K wires are inserted from the ulnar into the radius);
references:

ECU is usually affected but may occur in EDM
ulnar styloid may sustain avulsion frx & displace into distal RU joint with the extensor carpi ulnaris tendon.
exam reveals a vacant ECU sulcus (empty sulcus sign);
distal radio-ulnar joint is irreducible even after ORIF of radial frx;
ECU will be found either in RU joint or displaced in an ulnar direction around ulnar head;

to avoid chronic instability, the distal radio-ulnar joint is reduced & ECU tendon sheath is repaired;
surgical repair includes open reduction of distal RU joint, suture repair of ECU fibro-osseous canal, & ORIF of ulnar styloid frx;

30 yo WM who initially underwent ORIF of a Galeazzi frx w/o pin fixation of the RU joint;
several weeks lateral RU joint diastasis occur which required closed pinning as a second procedure;