Clinical Practice Guidelines

Galeazzi fracture-dislocation - Fracture clinics

  • Fracture Guideline Index

    See also: Galeazzi fracture-dislocation - Emergency Department

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?

    1. How often should these fractures be followed up in fracture clinics?

    Table 1: Recommended follow-up schedule for Galeazzi fracture-dislocations.

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    All types

    1 week post-injury with x-ray to assess position and alignment of the distal radioulnar joint (DRUJ)

    May need review in second week based on stability of the fracture and DRUJ; otherwise review at 6 weeks

    If DRUJ stabilised with pin, pin will need to be removed 4-6 weeks after injury

    Fractures with ulnar physeal injury need long-term review at 6-9 months to assess for growth arrest and any subsequent management

    The child needs to have full strength and range of movement (ROM) prior to return to sport. It will take 2-3 months for return to full contact sports

    Fractures with ulnar physeal injury need long-term review at 6-9 months to assess for growth arrest and any subsequent management

     

    2. What should I review at each appointment?

    Assessment of fracture healing and alignment of the DRUJ.

    3. What are the potential complications associated with this injury?

    There is a high risk (≤55%) of ulnar physeal injury with Galeazzi equivalent injuries. This can lead to ulna shortening and issues with the DRUJ, depending on the amount of growth remaining in the radius.

    Malunion of the radius can cause subluxation of the DRUJ. This can lead to pain and loss of motion through the forearm and wrist.

    Nerve injury is uncommon, but cases have been reported with injuries to the ulnar nerve. This usually resolves with observation.

    4. When should I refer for an orthopaedic consultant opinion?

    Indications for a consultant orthopaedic surgeon opinion are:

    • noncongruent DRUJ
    • loss of position through the fracture
    • ulnar physeal arrest

    5. What are the indications for discharge?

    Healed fracture with a clinically stable DRUJ.

    References (Outpatient setting)

    Atesok KI, Jupiter JB, Weiss AP. Galeazzi fracture. J Am Acad Ortho Surg 2011; 19: 623-33.

    Golz RJ, Grogan DP, Greene TL, Belsole RJ, Ogden JA. Distal ulnar physeal injury. J Pediat Ortho 1991; 11(3): 318-26.

    Waters PM, Bae DS. Fractures of the distal radius and ulna. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.292-346.

     

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    Content developed by Victorian Paediatric Orthopaedic Network
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