8/31/2020 Wheeless' Textbook of Orthopaedics

HOME ADVERTISE HERE EDITORIAL r:

CONTACT US SITE MAP MY ACCOUNT

Wheeless’ Textbook of Orthopaedics

Presented by Duke Orthopaedics

ARTHRITIS ARTHROSCOPY BONES DVT

DISASTER PREPAREDNESS TOOLBOX JOINTS LUMBAR SPINE ISSLS

MUSCLES TENDONS NERVES PERIOPERATIVE PAIN MANAGEMENT

TAR TRAUMA FRACTURES OTHER SEARCHES

EMAIL
ALERTS

Galeazzi's Fracture PRODUCT

INFORMATION

(Adults) advertisement

- 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 ulnar styloid may be
avulsed
www.wheelessonline.com/ortho/galeazzis_fracture_adults_1 1/6
8/31/2020 Wheeless' Textbook of Orthopaedics

- 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

- Treatment in Children
- Variant of Galeazzi fracture-dislocation in children.
- Galeazzi-equivalent injuries of the wrist in children.

- Surgical Treatment in Adults:

- 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:
- Galeazzi fracture-dislocation: a new treatment-oriented
classification.
- Internal fixation in 50 cases of Galeazzi fracture.
- Results of compression-plating of closed Galeazzi fractures.

- surgical approach:
- Anterior Approach of Henry;
- 5-6 inch longitudinal incision is made, centered over frx in
plane between FCR which is retracted ulnarly and BR;
- radial artery is identified & retracted to ulnar side;
- BR & superficial radial nerve are retracted radially;
- frx is located just above proximal border of pronator
quadratus;
- insertion of pronator quadratus is freed from radius &
reflected ulnarward;
- RU Joint:
- 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
www.wheelessonline.com/ortho/galeazzis_fracture_adults_1 2/6
8/31/2020 Wheeless' Textbook of Orthopaedics

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 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
- surgeon's non dominant hand keeps joint reduced and helps
to "triangulate the k wire" which is driven by 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:
- Galeazzi fractures: Is DRUJ instability predicted by current
guidelines?
- Distal radioulnar joint function after Galeazzi fracture-
dislocations treated by open reduction and internal plate fixation.
- Distal Radioulnar Joint Instability (Galeazzi Type Injury) After
Internal Fixation in Relation to the Radius Fracture Pattern.

- Post Op
- classic recommendations include, ORIF followed by immobilization
in long arm cast with forearm in full supination for 6-8 weeks;
- references:
- Surgical treatment of Galeazzi fracture
- Immobilization in supination versus neutral following surgical
treatment of Galeazzi fracture-dislocations in adults: case series.

- Complications:
- entrapment of extensor tendons:
- 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;

www.wheelessonline.com/ortho/galeazzis_fracture_adults_1 3/6
8/31/2020 Wheeless' Textbook of Orthopaedics

- Treatment:
- 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;
- RU joint subluxation
- Distal radioulnar joint function after Galeazzi fracture-
dislocations treated by open reduction and internal plate fixation.
- Distal Radioulnar Joint Instability (Galeazzi Type Injury) After
Internal Fixation in Relation to the Radius Fracture Pattern.

- case example:

- 30-year-old 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;

www.wheelessonline.com/ortho/galeazzis_fracture_adults_1 4/6
8/31/2020 Wheeless' Textbook of Orthopaedics

Galeazzi injury with an associated fracture of the radial head.

Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi

lesions)

Galeazzi fracture-dislocations.

Management of the Galeazzi fracture.

The Interosseous Membrane of the Forearm: Structure and Its Role in

Galeazzi Fractures.

Galeazzi fractures.

Treatment of Galeazzi fracture-dislocations.

The effect of a Galeazzi fracture on the strength of pronation and

supination two years after surgical treatment

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, November 17, 2016

10:38 am

ORTHOPAEDICS AND THE US MILITARY

National Military Family Association

www.wheelessonline.com/ortho/galeazzis_fracture_adults_1 5/6
8/31/2020 Wheeless' Textbook of Orthopaedics

Wounded Warrior Project

TEXT AUTHOR

Clifford R. Wheeless, III, M.D.

Orthopaedic Specialists of North Carolina

Dr. Wheeless enjoys and performs all types of

orthopaedic surgery but is renowned for his expertise in
total joint arthroplasty (Hip and Knee replacement) as
well as complex joint infections. He founded
Orthopaedic Specialists of North Carolina in 2001 and
practices at Franklin Regional Medical Center and Duke
Raleigh Hospital.

» More about Dr. Wheeless.

COPYRIGHT © 2020 DATA TRACE INTERNET

PUBLISHING, LLC - ALL RIGHTS RESERVED.

www.wheelessonline.com/ortho/galeazzis_fracture_adults_1 6/6