eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Galeazzi Fracture

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
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Updated: Dec 4, 2007

Introduction

The Galeazzi fracture-dislocation is an injury pattern involving a radial shaft fracture with associated dislocation of the distal radioulnar joint (DRUJ); the injury disrupts the forearm axis joint.

For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article Broken Arm.

History of the Procedure

The Galeazzi fracture injury pattern was first described 1842, by Cooper, 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 1957.¹

Problem

Galeazzi fractures are isolated fractures of the junction of the distal third and middle third of the radius with associated subluxation or dislocation of the DRUJ. (See also the eMedicine articles Fractures, Forearm and Radius, Distal Fractures.)

Frequency

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.

Etiology

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

Pathophysiology

The deforming forces include those of the brachioradialis, pronator quadriceps, 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.

Presentation

Pain and soft-tissue swelling are present at the distal-third radial fracture site and at the wrist joint. This injury is confirmed on radiographic evaluation.

Forearm trauma may be associated with compartment syndrome. See the eMedicine article Compartment Syndrome, Upper Extremity for further treatment information.

Anterior interosseous nerve (AIN) palsy may also be present, but it is often overlooked because there is no sensory component to this finding. A purely motor nerve, the AIN is a division of the median nerve. Injury to the AIN can cause paralysis of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index finger, resulting in loss of the pinch mechanism between the thumb and index finger.

Indications

Galeazzi fractures are best treated with open reduction of the radius and DRUJ. Closed reduction and cast application have led to unsatisfactory results. The term "fracture of necessity" refers to the fact that the adult Galeazzi fracture is not amenable to treatment by closed means, necessitating surgical stabilization.

Open forearm fractures constitute a surgical emergency. Open wounds may require incorporation into the surgical incision. Immediate stabilization of the radial fracture and the DRUJ is recommended.

Galeazzi fractures in skeletally immature patients are typically treated with closed reduction and casting because of the enhanced viscoelastic nature of pediatric bone, as well as the presence of a stout periosteal sleeve.

Relevant Anatomy

See Intraoperative Details.²

Contraindications

The only contraindication to surgical intervention is the existence of life-threatening conditions, which take priority. In these situations, definitive surgical management is deferred until the patient is stabilized.

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