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Galeazzi Fracture
Galeazzi fracture is a fracture of the distal 1/3 of the radius with disruption of the distal radioulnar joint (DRUJ). The fracture is always located above the proximal border of the pronator quadratus. The pronator quadratus rotates the distal fragment towards the ulna and pulls it proximally. We usually fix the fractured radius, and we then evaluate DRUF for instability after we fix the distal radius. If you have instability, make sure that the joint is reduced, then you will do percutaneous fixation of that joint. If you don’t have instability, you will do nothing or maybe give a long arm splint in supination if you think the patient needs the splint. Basically, you will need intraoperative evaluation of the DRUJ. Not all distal radial fractures will be associated with distal radioulnar joint instability. They found that if the radius fracture is less than 7.5 cm from the join, then the distal radioulnar joint can be unstable. If the fracture radius is more than 7.5cm from the joint, then the distal radioulnar joint will be rarely unstable. So the closer the fracture of the radius is to the joint, the more likely that the distal radioulnar joint is involved, and we need to work diligently to find the problem and address it. The problem can be instability of the DRUJ. You may find an ulnar styloid fracture or you find that the radius is short (about 5 mm or more). In the AP view of the wrist, you may find widening of the joint or in the lateral view, you find that the ulna goes dorsally or volarly. The distal radioulnar joint has ligaments, volar and dorsal, that stabilize the joint, and that joint is usually stable in supination. Sometimes in old, complicated or difficult cases, you can’t really evaluate the distal radioulnar joint without getting a CT scan of both wrists (make sure that you position the wrist in the same position. Anatomic reduction and fixation of the radius with a volar plate. Then you assess the stability of the distal radioulnar joint. If the distal radial ulnar joint remains unstable, supination of the wrist may reduce that joint. If not, either a closed reduction or open reduction with pinning of the joint is done. If after anatomic restoration and plate fixation of the radius, the distal radioulnar joint remains irreducible, then the structure that is most likely obstructing the reduction is the extensor carpi ulnaris. It is imperative to recognize the problem of Galeazzi fracture, which is the distal radioulnar joint injury. The treatment of the problem acutely is better than late reconstruction. When you fix the radius, make sure that the radial bow is restored. The reduction of the joint is done by supination of the forearm, and you do immobilization in supination if the distal radioulnar joint is stable following open reduction of the distal radius. So there is an obvious injury that you will see, and you will test that injury and see if the joint is stable in supination. If it is, keep the forearm in supination. You will do pin fixation if the joint is reducible, but is unstable. The pin fixation will be done by cross pinning from the ulna to the radius and leave the pins for about 4 weeks. You can do open reduction of the joint if the joint is not reduced and something is blocking the reduction, such as the extensor carpi ulnaris tendon. If there is a large ulnar styloid process fracture, you probably need to open that fracture after you fix the radius, and then do open reduction and internal fixation of the large ulnar styloid fragment and immobilize the forearm in supination. It might be difficult to evaluate the stability of the distal radial ulnar joint. In general, the DRUJ is stable in most cases after anatomic reconstruction of the radius.