Galeazzi fracture
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].
Overview
The Galeazzi fracture-dislocation is an orthopedic injury pattern with the following definition:
- An isolated fractures of the distal 1/3 radius shaft
- Associated distal radioulnar joint (DRUJ) injury
Historical Perspective
In 1822, Sir Astley Cooper worked on the dislocations and Fracture of human body.
In 1934, Riccardo Galeazzi , an Italian surgeon at the Instituto de Rachitici in Milan, reported on his experience with 18 fractures with with close similarities to the Monteggia lesion.
In 1941, Campbell termed the Galeazzi fracture the "fracture of necessity".
In 1957, Hughston presented the definitive management of the Galeazzi fracture.
Causes
The main etiology of the Galeazzi fracture is thought to be an axial loading may be placed on a hyperpronated forearm during falling onto an outstretched hand (FOOSH) with an extended wrist and hyperpronated forearm. Because at this posture the energy from the radius fracture transmitted towards the radioulnar joint cause the dislocation of the DRUJ.
Differentiating Galeazzi fracture fracture from other Diseases
Epidemiology and Demographics
Galeazzi fractures account for around 3-7% of all forearm fractures in adults. Normally, 25% of the radial shaft fractures are true Galeazzi injuries. The most common risk factors for the Galeazzi fracture are: sports (football and wrestling), osteoporosis, and post-menopausal time; consequently, These risk factors cause the highest occurrence in young males (10:10,000) and elderly females (5:10,000). The peak incidence in children is the age of 9 to 12.
Risk Factors
Screening
Natural History, Complications and Prognosis
Natural History
Complications
The overall complication rate in the treatment of Galeazzi fractures were found in around 40% of cases:
- Neurovascular compromise: such as Ulna nerve damage
- Compartment syndrome
- Chronic disability of the DRUJ
- Physeal Injury
- Malunion of the radius
- Nonunion
- Infection
- Refracture following plate removal
- Posterior interosseois nerve (PIN) injury.
- Instability of the DRUJ
Prognosis
Successful treatment of Galeazzi fractures depends on the on-time interventions such as: reduction of the radius and DRUJ and the restoration of the forearm axis. The incidence of nonunion of Galeazzi fractures is very low. On the other hand, the rate of successful union following the open reduction of forearm fractures was reported around 98%. Previous researches showed that the loss of strength at the supination and pronation were found in 12.5% and 27.2%, respectively.
Diagnosis
The diagnosis of a Galeazzi fracture should be confirmed using a radiographic examination. The two main views such as anteroposterior (AP) and lateral forearm are needed in this regard:
- Radial shaft fracture:
- Commonly found at the junction of the middle and distal third
- Dorsal/Volar angulation
- Radial shortening may occur
- Dislocation of the distal radioulnar joint
Meanwhile, the following mentioned findings on the obtained radiography (such as plain radiography and the bilateral axial computed tomography (CT)) are suggestive of injury to the distal radioulnar joint (DRUJ):
- The dislocated radius near to the injury site
- Shortened radius by more than 5 mm near to the injury site
- The ulnar styloid base fracture near to the injury site
- Widening of the DRUJ space near to the injury site
History and Symptoms
Normally the pain and soft-tissue swelling are found at the injury site (distal-third radial fracture site and at the wrist joint). This injury should be confirmed using a radiographic evaluations. Also, patients may loss the pinch mechanism between their thumb and their index finger which can be due to the paralysis of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP).
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Immediate stabilization of patients is the first step. Then the radial fracture and the DRUJ stabilization is recommended in these cases. Open forearm fractures considered as a surgical emergency. Galeazzi fractures occurs in younger patients who are skeletally immature; the normally they treated using a closed reduction and casting. Since closed reduction and cast application have led to unsatisfactory results. Then, Almost always the open reduction are necessary for the Galeazzi fractures. There are controversies regarding the indications for intramedullary nailing of forearm fractures.
Non-Operative Treatment
Surgery
All adult Galeazzi fractures should be considered to be treated with open reduction and internal fixation (ORIF).