eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Galeazzi Fracture: Follow-up

Author: Janos P Ertl, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, University of California at Davis; Director of Amputee Clinic, Chief of Orthopedic Trauma, Kaiser Hospital
Contributor Information and Disclosures

Updated: Dec 4, 2007

Outcome and 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 1957.1 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 in these fractures. 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%.5

Reckling and Moore separately reported satisfactory results with compression plating and immobilization in supination.6,7

Future and Controversies

In the future, statically locked intramedullary nailing may prove to be an option for the treatment of Galeazzi fractures, provided that it can neutralize and control the multiple deforming forces associated with these injuries. The indications for intramedullary nailing of forearm fractures have not been clearly defined.

 


More on Galeazzi Fracture

Overview: Galeazzi Fracture
Workup: Galeazzi Fracture
Treatment: Galeazzi Fracture
Follow-up: Galeazzi Fracture
Multimedia: Galeazzi Fracture
References
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References

  1. Hughston JC. Fracture of the distal radial shaft; mistakes in management. J Bone Joint Surg Am. Apr 1957;39-A(2):249-64; passim. [Medline].

  2. Mulford JS, Axelrod TS. Traumatic injuries of the distal radioulnar joint. Orthop Clin North Am. Apr 2007;38(2):289-97, vii. [Medline].

  3. Saitoh S, Seki H, Murakami N. Tardy ulnar tunnel syndrome caused by Galeazzi fracture-dislocation: a neuropathy with a new pathomechanism. J Orthop Trauma. Jan 2000;14(1):66-70. [Medline].

  4. Alexander AH, Lichtman DM. Irreducible distal radioulnar joint occurring in a Galeazzi fracture - case report. J Hand Surg [Am]. May 1981;6(3):258-61. [Medline].

  5. Wei SY, Born CT, Abene A. Diaphyseal forearm fractures treated with and without bone graft. J Trauma. Jun 1999;46(6):1045-8. [Medline].

  6. Moore TM, Klein JP, Patzakis MJ. Results of compression-plating of closed Galeazzi fractures. J Bone Joint Surg Am. Sep 1985;67(7):1015-21. [Medline].

  7. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg Am. Jul 1982;64(6):857-63. [Medline].

  8. Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. Feb 1989;71(2):159-69. [Medline].

  9. Giannoulis FS, Sotereanos DG. Galeazzi fractures and dislocations. Hand Clin. May 2007;23(2):153-63, v. [Medline].

  10. Hertel R, Pisan M, Lambert S. Plate osteosynthesis of diaphyseal fractures of the radius and ulna. Injury. Oct 1996;27(8):545-8. [Medline].

  11. Kraus B, Horne G. Galeazzi fractures. J Trauma. Nov 1985;25(11):1093-5. [Medline].

  12. Mikic ZD. Galeazzi fracture-dislocations. J Bone Joint Surg Am. Dec 1975;57(8):1071-80. [Medline].

  13. Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res. May 1983;(175):25-9. [Medline].

  14. Wright RR, Schmeling GJ, Schwab JP. The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review. J Orthop Trauma. May 1997;11(4):288-94. [Medline].

  15. Wyrsch B, Mencio GA, Green NE. Open reduction and internal fixation of pediatric forearm fractures. J Pediatr Orthop. Sep-Oct 1996;16(5):644-50. [Medline].

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Further Reading

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Keywords

Galeazzi fracture-dislocation, reverse Monteggia fracture, Piedmont fracture, Darrach-Hughston-Milch fracture, fracture of necessity, radial shaft fracture, dislocation of the distal ulna, forearm fracture, broken arm

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Contributor Information and Disclosures

Author

Janos P Ertl, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, University of California at Davis; Director of Amputee Clinic, Chief of Orthopedic Trauma, Kaiser Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Hungarian Medical Association of America, Orthopaedic Trauma Association, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Peter M Murray, MD, Associate Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital
Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand, American Society of Reconstructive Microsurgery, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center, Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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