GALEAZZI FRACTURELaurie Grove

AIMS8/30/2010

• The Galeazzi fracture-dislocation, as shown on the next page, is an injury pattern involving a radial shaft fracture with associated dislocation of the distal radioulnar joint (DRUJ); the injury disrupts the forearm axis joint.

• This anteroposterior radiograph demonstrates a classic Galeazzi fracture: a short oblique or transverse fracture of the radius with associated dislocation of the distal ulna. The dislocation results from the disruption of the DRUJ (distal radio-ulnar joint). Note the prominence of the distal ulna (ulna positive variance).

• History of the Procedure• In 1934, Ricardo Galeazzi (1866-1952), an Italian surgeon

in Milan, reported on his experience with 18 fractures with the above-described pattern as a compliment to the Monteggia lesion. Such fractures have since become synonymous with his name.

• In 1941, Campbell termed the Galeazzi fracture the "fracture of necessity," because it necessitates surgical treatment; in adults, nonsurgical treatment of the injury results in persistent or recurrent dislocations of the distal ulna.

• Frequency• Galeazzi fractures account for 3-7% of all forearm

fractures. They are seen most often in males. Although Galeazzi fracture patterns are reportedly uncommon, they are estimated to account for 7% of all forearm fractures in adults. The distal forearm is the most frequent site of fracture in children; the distal radius is the most frequently injured physis. Falls are the usual mechanism of injury.

• Etiology• The etiology of the Galeazzi fracture is thought to be a fall

that causes an axial load to be placed on a hyperpronated forearm.

• Pathophysiology• The deforming forces include those of the brachioradialis, pronator

quadriceps, and thumb extensors, as well as the weight of the hand. The deforming muscular and soft-tissue injuries that are associated with this fracture cannot be controlled with plaster immobilization.

• Presentation• Pain and soft-tissue swelling are present at the distal-third radial fracture

site and at the wrist joint. This injury is confirmed on radiographic evaluation. Forearm trauma may be associated with compartment syndrome. (See next slide for def.)

• Anterior interosseous nerve (AIN) palsy may also be present, but it is often overlooked because there is no sensory component to this finding. A purely motor nerve, the AIN is a division of the median nerve. Injury to the AIN can cause paralysis of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index finger, resulting in loss of the pinch mechanism between the thumb and index finger.

• Overview- Compartment syndrome is the compression of nerves and blood vessels within an enclosed space. This leads to muscle and nerve damage and problems with blood flow.

• Symptoms- The hallmark symptom of compartment syndrome is severe pain that does not go away when you take pain medicine or raise the affected area. In more advanced cases, symptoms may include:

• Decreased sensation• Paleness of skin • Weakness

• Indications• Galeazzi fractures are best treated with open reduction of the

radius and DRUJ. Closed reduction and cast application have led to unsatisfactory results. The term "fracture of necessity" refers to the fact that the adult Galeazzi fracture is not amenable to treatment by closed means, necessitating surgical stabilization.

• Open forearm fractures constitute a surgical emergency. Open wounds may require incorporation into the surgical incision. Immediate stabilization of the radial fracture and the DRUJ is recommended.

• Galeazzi fractures in skeletally immature patients are typically treated with closed reduction and casting because of the enhanced viscoelastic nature of pediatric bone, as well as the presence of a stout periosteal sleeve.1,4,5

• Original Article Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria

• Galeazzi Lesions in Children and Adolescents: Treatment and Outcome

• Robert Eberl, Georg Singer, Johannes Schalamon, Thomas Petnehazy and Michael E. Hoellwarth

• Clinical Orthopaedics and Related Research® • Volume 466, Number 7, 1705-1709, DOI:

10.1007/s11999-008-0268-6

• Abstract • Treatment in children and adolescents is usually possible with closed reduction

and casting. The objective of this retrospectively designed study was to describe all Galeazzi lesions treated at our department during a 3-year period.

• One hundred ninety-eight patients with displaced fractures of the radius alone or both bones of the forearm were reviewed. In 26 (13%) cases, a Galeazzi lesion was found and these patients formed the study group. Outcome was assessed using the Gartland-Werley score. Eight of 26 (31%) fractures were recognized initially and classified as a Galeazzi lesion. Casting after fracture reduction was possible in 22 patients. Thirteen patients were treated with immobilization in a below-elbow cast and nine with an above-elbow cast. Four patients were treated operatively.

• The results were excellent in 23 cases and good in three cases. In cases of distal forearm fractures, a possible Galeazzi lesion should be considered. However, proper reduction of the radius with concomitant reduction of the distal radioulnar joint and cast immobilization provides good to excellent outcome even if the Galeazzi lesion is primarily not recognized.