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See also: Galeazzi fracture-dislocation - Fracture clinics
Galeazzi fracture-dislocations are often missed and may be difficult to recognise. If there is an isolated radius fracture, always examine the distal radioulnar joint (DRUJ) on x-ray.
For all Galeazi fracture-dislocations, the arm should be splinted and the nearest orthopaedic on call service should be consulted.
A Galeazzi fracture-dislocation is a fracture of the distal third of the shaft of the radius with a disruption to the DRUJ.
They can be classified by the direction of the ulna displacement:
These injuries are very rare in children. The most common mechanism is a fall on an outstretched hand with forearm rotation.
More common is the Galeazzi equivalent, where there is a distal radius fracture with a distal ulna physeal fracture but without disruption of the DRUJ (Figure 1).
Figure 1: A Galeazzi equivalent injury is characterised by fracture of the radius with fracture through the distal growth plate of the ulna but without disruption of the DRUJ.
There will be swelling at the distal forearm and/or wrist. The forearm and wrist will be painful to move. Deformity through the forearm is usually clinically evident.
Anteroposterior (AP) and lateral x-ray of the forearm, which includes the wrist and elbow, should be obtained.
These fractures are often missed and may be difficult to recognise. If there is an isolated radius fracture, always examine the DRUJ on x-ray.
Figure 2: 14 year old boy with Galeazzi fracture-dislocation. The ulna is displaced dorsally.
For children, most of these fractures can be managed with closed reduction. Fluoroscopy should be used to assess stability of the DRUJ after reduction.
Adolescents are more likely to need open or percutaneous fixation to stabilise the DRUJ after reduction.
All Galeazzi fracture-dislocations should be referred to the nearest orthopaedic on call service.
Other indications for prompt consultation include:
The arm should be splinted and the nearest orthopaedic on call service consulted.
Follow-up in fracture clinic needs to be in 7 days with an x-ray. This should be arranged by the consulting orthopedic team after their reduction and stabilisation of the injury.
The majority of these fractures will do well. Poor outcomes are usually a result of a delayed diagnosis or if the forearm has been immobilised in an incorrect position or in a below-elbow cast.
Delayed diagnosis is a frequent complication. Nerve injury is uncommon, but cases have been reported with injuries to the ulnar nerve. This usually resolves with observation.
See fracture clinics for other potential complications.
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