- Galeazzi injuries are fractures of the radial shaft associated with disruption of the distal radioulnar joint (DRUJ)
- These fractures are unstable and require open surgery for anatomic and rigid fixation of the radius shaft and stabilization of the DRUJ
- In children, a fracture of the radial shaft is sometimes associated with separation of the distal ulnar epiphysis without disruption of the DRUJ, and closed reduction is often successful
- In adults, a fracture of the radial shaft can be associated with an additional fracture of the distal ulna; this injury is considered a Galeazzi equivalent and treated the same way as a Galeazzi fracture
- Anatomic restoration of the radius shaft usually obtains reduction of the DRUJ; DRUJ stability should be carefully assessed intra-operatively and addressed accordingly
Subscribe to the latest updates from Orthopaedics Advances in Motion
Fractures of the radius shaft associated with a dislocation of the distal radioulnar joint (DRUJ) are called Galeazzi fractures. These injuries usually occur as a result of high-energy trauma (e.g., motor vehicle accident, sports injury or a fall from a height) or a fall on an outstretched and pronated hand.
In Hand Clinics, orthopedic surgeons Rohit Garg, MD, MBBS, and Chaitanya S. Mudgal, MD, in the Hand and Arm Center at Massachusetts General Hospital, reviewed the evaluation and treatment of Galeazzi fractures, which are sometimes called Piedmont fractures, reverse Monteggia fractures or Darrach–Hughston–Milch fractures.
Galeazzi patients usually present with swelling and deformity of the forearm. Neurovascular damage is rare.
Essential imaging includes good anteroposterior (AP) and lateral radiographs of the forearm, as well as orthogonal views of the wrist and elbow. Signs suggestive of DRUJ disruption are:
- Fracture at the base of the ulnar styloid
- Widening of the DRUJ space (on a true AP view)
- Dislocation of the radius relative to the ulna (on a true lateral view)
- More than 5 mm of shortening of the radius relative to the ulna
In some cases, injury to the DRUJ is purely ligamentous. Computed tomography (CT) or a radiograph of the contralateral wrist can be useful for assessing the DRUJ.
Treatment of Adults
Adults with a Galeazzi fracture require open surgery for anatomic and rigid fixation of the radius shaft and stabilization of the DRUJ. Plate and screw fixation is the preferred method, and the review describes the technique in detail, including how to address comminution. DRUJ stability should be carefully assessed intraoperatively and addressed accordingly.
Deforming forces (e.g., from the brachioradialis, pronator quadratus and the weight of the hand) make it difficult to control these fractures in a cast, hence there is a high percentage of failure with non-operative management. Alternative fixation, such as Kirschner wires and intramedullary pins, are not rigid enough to resist deforming forces and are unable to control rotation and allow shortening of the radius.
In children, a fracture of the radial shaft is sometimes associated with the separation of the distal ulnar epiphysis without disruption of the DRUJ. In adults, a fracture of the radial shaft can be associated with an additional fracture of the distal ulna. These injuries, termed Galeazzi equivalents, are normally treated the same way as a Galeazzi fracture. However, closed reduction is often successful in children.
Certain high-energy metadiaphyseal injuries are essentially a combination of distal radius fracture and a Galeazzi fracture. These can be treated, first, with distal radius articular restoration, and then, with the standard treatment of the Galeazzi fracture. Stacked plating has also been suggested.
Complications of surgery for Galeazzi fractures are similar to those for other forearm fractures—nonunion, delayed union, malunion, nerve injuries and infection. Plate removal should not be done routinely, and, if needed, it should not be done earlier than 18 months after surgery because of the risk of refracture.
Risk factors for refracture after plate removal are:
- Use of 4.5 mm plates
- Removal before 12 months
- A comminuted or displaced fracture pattern
- Unrestricted activity immediately after plate removal
Learn more about the Hand & Arm Center at Mass General
Refer a patient to the Department of Orthopaedic Surgery