Galeazzi Fracture

HPI: Adult male presents after being involved in a motor vehicle collision with right wrist pain and obvious distal deformity.

PE: Obvious deformity of the right wrist. No abrasions or ecchymosis. Full thumb abduction, able to flex at DIP and PIP joint of all 5 fingers, full abduction of all 4 palmar fingers, 5/5 strength to finger grip. Slightly limited range of motion to flexion or extension wrist secondary to pain. Significant pain with pronation and supination. Normal sensation to pinprick and two point discrimination of all five fingers. 2+ radial pulse with normal cap refill. 

Imaging:

How to Diagnosis:

Radial shaft fracture and concurrent distal radioulnar joint. Most commonly seen in fractures of the distal 1/3 of the radius. Termed a Galeazzi fracture. Typically occurs secondary to direct wrist trauma (most classically dorsolateral) or with fall onto outstretched hand with forearm in pronation. 

Anatomy:

• Radius and ulnar articulate along the sigmoid notch of the radius. 
  
• Radioulnar ligaments along the volar and dorsal ligaments. 
  
• This  relationship confers the stability of supination and pronation.

Treatment:

• Requires ORIF of radius with reduction and stabilization of DRUJ. 
  

Pearls:

• Key distance of radial fracture is 7.5cm from articular surface. DRUJ is unstable in 55% of fractures < 7.5cm, unstable in only 6% of fractures > 7.5cm. 
  
• Concurrence of fracture and distal dislocation causes significant instability of supination and pronation.
  
• Requires operative fixation, especially critical if fracture is < 7.5cm from articulating surface of radius.