Background

The Galeazzi fracture-dislocation is an injury pattern involving isolated fractures of the junction of the distal third and middle third of the radius with associated subluxation or dislocation of the distal radioulnar joint (DRUJ); the injury disrupts the forearm axis joint.^[1]  (See also Forearm Fractures in Emergency Medicine and Distal Fractures of the Radius.)

The Galeazzi fracture injury pattern was first described by Cooper in 1842, 92 years before Galeazzi reported his results. Ricardo Galeazzi (1866-1952), an Italian surgeon at the Instituto de Rachitici in Milan, was known for his extensive work experience on congenital dislocation of the hip. In 1934, he 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. Although researchers have been unable to reproduce the mechanism of injury in a laboratory setting, Hughston outlined the definitive management of these fractures in 1957.^[2]

Next

Pathophysiology and Etiology

The deforming forces in a Galeazzi fracture include those of the brachioradialis, pronator quadratus, 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.

The etiology of the Galeazzi fracture is thought to be a fall that causes an axial load to be placed on a hyperpronated forearm.

Epidemiology

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.

Prognosis

Successful treatment of Galeazzi fractures depends on the reduction of the radius and DRUJ and the restoration of the forearm axis. Hughston outlined the difficulties and complications of nonoperative treatment in 1957.^[2] An unsatisfactory result—caused by a loss of reduction that, in turn, led to malunion—was identified in 92% of patients (35 of 38) treated with closed reduction and cast immobilization.

Hughston's study attributed loss of reduction to the deforming force of the brachioradialis, the pull of the pronator quadratus (leading to rotation of the distal radial fragment towards the ulna), and the weight of the hand as a deforming force (leading to dorsal angulation of the radius and subluxation of the DRUJ). These deforming forces cannot be controlled with plaster immobilization; operative management is required. The incidence of nonunion of Galeazzi fractures is very low. The rate of union following the open reduction of forearm fractures has been reported to approach 98%.^[3]

Reckling and Moore separately reported satisfactory results with compression plating and immobilization in supination.^{[4, 5]}

Eberl et al retrospectively reported on Galeazzi lesions over a 3-year period in 26 patients. Casting after fracture reduction was possible in 22 patients, 13 of whom were treated with immobilization in a below-elbow cast and 9 of whom were treated with an above-elbow cast. Four patients were treated operatively. Results were excellent in 23 cases and good in 3 cases. The authors noted that in all cases of distal forearm fractures, a possible Galeazzi lesion should be considered but that proper reduction of the radius with concomitant reduction of the DRUJ and cast immobilization provides good-to-excellent outcome even if the Galeazzi lesion is not recognized primarily.^[6]

Ploegmakers et al retrospectively reviewed Galeazzi fractures to determine their effect on the strength of pronation and supination at a mean of 2 years after surgery.^[7] They found that the mean absolute loss of strength of supination in the injured arm compared with the noninjured arm throughout all ranges of forearm rotation was 16.1 kg, corresponding to a relative loss of 12.5%. For the strength of pronation, the mean loss was 19.1 kg, corresponding to a relative loss of 27.2%.

Loss of strength of supination following a Galeazzi fracture correlated with poor quickDASH and PRWE scores. Loss of strength of pronation (27.2%), and of supination (12.5%) in particular, after a Galeazzi fracture is associated with worse clinical scores, highlighting the importance of supination of the forearm in function of the upper limb.^[7]

Ilyas et al found that intramedullary nails for displaced distal radius fractures can result in good functional outcome but with a high incidence of complications.^[8] The authors did not identify any long-term soft tissue problems but noted that intramedullary nails should be limited to extra-articular and simple intra-articular distal radius fractures.

In this study, 10 patients with AO type A and C distal radius fractures underwent fracture fixation.^[8] All cases maintained reduction between postoperative and final radiographs, except for two cases of AO type A3 fractures with a loss of volar tilt greater than 5º. Grip strength relative to the uninjured limb was 91%. According to the Disabilities of the Arm, Shoulder, and Hand questionnaire, eight results were excellent, one good, and one poor. There were two cases of transient superficial radial sensory neuritis and three cases of screw penetration into the DRUJ. There were no cases of infection, tendon injury, or hardware failure or removal.

Clinical Presentation