Maharsh K. Patel
Joseph J. King
Galeazzi fractures are defined as a fracture of the distal one-third radial shaft and associated distal radioulnar joint (DRUJ) injury.
Variants—fractures anywhere along the radius or fractures of both the radius and ulna with DRUJ disruption
DRUJ is the distal articulation of the ulna within the sigmoid notch on the ulnar border of the distal radius.
Primarily stabilized by triangular fibrocartilage complex (TFCC)
Also has volar and dorsal distal radioulnar ligaments
DRUJ is most stable in supination.
Incidence of DRUJ instability
Unstable in 55% when radius fracture is <7.5 cm from articular surface
Unstable in 6% when radius fracture is >7.5 cm from articular surface
Major deforming forces
Pronator quadratus—insertion pronates the distal radius with proximal and volar displacement
Thumb extensors and abductors—result in shortening and relaxation of the radial collateral ligament
Mechanism of injury
Indirect trauma such as a fall onto an outstretched hand with the forearm in pronation (Figure 30.1)
Forceful axial loading with torsion of forearm
Direct trauma to the forearm and/or wrist
Motor vehicle accidents, blunt trauma, etc.
≤3% of all forearm fractures in children
≤7% of all forearm fractures in adults
Symptoms include local pain, swelling, deformity, decreased wrist range of motion after associated history of forearm trauma.
Physical examination—see Figure 30.2
Tenderness and swelling of the distal forearm
Limited and painful wrist motion and forearm pronation/supination
Prominent distal ulna
DRUJ stress causes wrist or forearm pain.
Neurovascular examination; however, neurovascular injury is rare
Imaging—see Figure 30.3
Definitive diagnosis typically made with plain radiographs
Anteroposterior (AP)/lateral views of the forearm, wrist, and elbow
Signs of possible DRUJ injury on imaging
Dorsal or volar displacement of the distal ulna on the lateral wrist view
Widening or incongruity of DRUJ on AP view
Ulnar styloid fracture at the base
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