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Galeazzi Fracture

  • Author: Janos P Ertl, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Mar 11, 2016
 

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]

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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.

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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.

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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.

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Contributor Information and Disclosures
Author

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

William J Brackett, MD Research Assistant, Department of Orthopedic Surgery, Indiana University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Yaszemski, MD, PhD Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

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, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern 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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Peter M Murray, MD Professor and Chair, Department 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 Orthopaedic Association, American Society for Reconstructive Microsurgery, Orthopaedic Research Society, Society of Military Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Florida Medical Association

Disclosure: Nothing to disclose.

References
  1. Atesok KI, Jupiter JB, Weiss AP. Galeazzi fracture. J Am Acad Orthop Surg. 2011 Oct. 19(10):623-33. [Medline].

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

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

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

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

  6. Eberl R, Singer G, Schalamon J, Petnehazy T, Hoellwarth ME. Galeazzi lesions in children and adolescents: treatment and outcome. Clin Orthop Relat Res. 2008 Jul. 466(7):1705-9. [Medline]. [Full Text].

  7. Ploegmakers JJ, The B, Brutty M, Ackland TR, Wang AW. The effect of a Galeazzi fracture on the strength of pronation and supination two years after surgical treatment. Bone Joint J. 2013 Nov. 95-B(11):1508-13. [Medline].

  8. Ilyas AM, Thoder JJ. Intramedullary fixation of displaced distal radius fractures: a preliminary report. J Hand Surg Am. 2008 Dec. 33(10):1706-15. [Medline].

  9. Galanopoulos I, Fogg Q, Ashwood N, Fu K. A widely displaced Galeazzi-equivalent lesion with median nerve compromise. BMJ Case Rep. 2012 Aug 18. 2012:[Medline].

  10. Kontakis GM, Pasku D, Pagkalos J, Katonis PG. The natural history of a mistreated ipsilateral Galeazzi and Monteggia lesion: report of a case 39 years post-injury. Acta Orthop Belg. 2008 Aug. 74(4):546-9. [Medline].

  11. Mitsui Y, Yagi M, Gotoh M, Inoue H, Nagata K. Irreducible Galeazzi-equivalent fracture in a child: an unusual case. J Orthop Trauma. 2009 Jan. 23(1):76-9. [Medline].

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

  13. Lendemans S, Taeger G, Nast-Kolb D. [Dislocation fractures of the forearm. Galeazzi, Monteggia, and Essex-Lopresti injuries]. Unfallchirurg. 2008 Dec. 111(12):1005-14; quiz 1015-6. [Medline].

  14. Macintyre NR, Ilyas AM, Jupiter JB. Treatment of forearm fractures. Acta Chir Orthop Traumatol Cech. 2009 Feb. 76(1):7-14. [Medline].

  15. Park MJ, Pappas N, Steinberg DR, Bozentka DJ. Immobilization in supination versus neutral following surgical treatment of Galeazzi fracture-dislocations in adults: case series. J Hand Surg Am. 2012 Mar. 37(3):528-31. [Medline].

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

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

  18. Sabat D, Dabas V, Dhal A. Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation. Indian J Orthop. 2014 Jul. 48 (4):426-8. [Medline].

  19. Nagy MT, Ghosh S, Shah B, Sankar T. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation. BMJ Case Rep. 2014 Apr 16. 2014:[Medline].

 
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Anteroposterior radiograph demonstrates classic Galeazzi fracture: short oblique or transverse fracture of radius with associated dislocation of distal ulna. Dislocation results from disruption of distal radioulnar joint (DRUJ). Note prominence of distal ulna (ulna positive variance).
 
 
 
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