The Case:
A 41 year-old man presents to the ED with right wrist pain after flipping off of his bicycle. On examination, there is obvious deformity and edema of the right wrist with significant tenderness to palpation of wrist. Radiographs are obtained.
Interpretation: Complete displaced fracture of the distal radial diaphysis. Dorsal displacement of the distal fragment. Dislocated distal radio-ulnar joint. Findings are consistent with a Galeazzi fracture-dislocation.
Management: Closed reduction with procedural sedation was performed by the orthopedic surgery resident, but the patient was taken to the OR for ORIF.
Why it matters? A Galeazzi fracture-dislocation is a fracture of the distal radius with associated dislocation of the distal radioulnar joint. Galeazzi fractures are primarily found in children; however, they make up approximately 7% of all adult forearm fractures. They are most commonly a result of a fall onto an outstretched hand with the wrist extended and forearm hyper pronated.
Treatment in children is usually conservative with closed reduction and splinting. Adults have poor outcomes with closed reduction, and surgical intervention with ORIF is preferred. There is a high morbidity associated with Galeazzi fractures in adults despite surgical intervention. Complications include malunion, nonunion, compartment syndrome and radioulnar synostosis.
Written by:
Dr. Jasmine Hill, MD
Emergency Medicine, PGY-2
Cook County Health
Reviewed by:
Dr. Scott Sherman, MD
Associate Program Director
Cook County Health
Resources:
Alexander, AH, Lichtman, DM. Irreducible distal radioulnar joint in a Galeazzi fracture—case report. J Hand Surg Am. 1981;6(3):258-261.
Carlsen, Brian T et al. “Acute dislocations of the distal radioulnar joint and distal ulna fractures.” Hand clinics vol. 26,4 (2010): 503-16. doi:10.1016/j.hcl.2010.05.009
Yohe, Nicholas J et al. “Irreducible Galeazzi Fracture-Dislocations.” Hand (New York, N.Y.) vol. 14,2 (2019): 249-252. doi:10.1177/1558944717744334