Galeazzi fracture

What is a Galeazzi fracture?

A Galeazzi fracture involves a fracture of the distal radial shaft combined with a disruption of the distal radioulnar joint (DRUJ). This specific injury destabilizes forearm rotation by uncoupling the two primary bones of the forearm. It accounts for approximately 3% to 7% of adult forearm fractures.

This injury typically follows a fall onto an outstretched hand with the wrist extended and the forearm pronated or hyperpronated. Early recognition is vital to prevent chronic instability. Failure to restore the relationship between the radius and ulna leads to long-term joint dysfunction.

What are the most common causes of a Galeazzi fracture?

Axial loads transmitted through the wrist during a fall on a pronated forearm drive this injury. These forces displace the distal radius and strain the interosseous membrane. Consequently, the DRUJ capsule and the triangular fibrocartilage complex (TFCC) fail under high shear stress.

High-energy trauma in younger individuals and osteoporotic bone in older adults serve as primary risk factors. A clinical comparison of Monteggia vs Galeazzi fractures highlights that Monteggia fractures involve a proximal ulnar fracture and radial head dislocation. In contrast, a Galeazzi fracture targets the distal radius and the DRUJ.

What are the signs and symptoms of a Galeazzi fracture?

Individuals experience immediate wrist pain, significant swelling, and a restricted ability to rotate the forearm. Physical examination often reveals tenderness along the radial shaft and over the DRUJ. A prominent or dorsally displaced ulnar head may alter the normal wrist contour and suggest DRUJ disruption.

Active pronation and supination are typically very painful and limited. Guarding of the wrist is a common finding, especially when the forearm is in a pronated position. Accurate diagnosis requires the clinician to associate radial shaft tenderness with instability at the wrist.

How is a Galeazzi fracture diagnosed?

Standard forearm radiographs confirm the radial shaft fracture and demonstrate DRUJ widening or subluxation. Additional wrist views often reveal dorsal or volar ulnar displacement. If the alignment remains ambiguous on X-ray, high-resolution CT scans provide a more detailed assessment of the joint space.

Physical examination should also assess for tenderness and instability at the distal radioulnar joint, with comparison to the contralateral side when needed. Any asymmetry may suggest DRUJ injury.

How is a Galeazzi fracture treated?

In adults, definitive care requires open reduction and internal fixation (ORIF) of the radial shaft. Surgeons must restore proper length, alignment, and rotation to the bone. The DRUJ is then assessed for stability once the radial fracture is secure. In children, closed reduction and above-elbow casting is often effective, with surgery reserved for irreducible or unstable injuries.

If the DRUJ remains unstable after fixation of the radius, percutaneous pinning and, in selected cases, open reduction or TFCC repair may be required. In adults, closed treatment often fails because of the inherent instability of the DRUJ. Postoperative care focuses on a period of immobilization followed by guided rehabilitation to regain the functional range of motion.

What are the most important facts to know about a Galeazzi fracture?

• A Galeazzi fracture is a distal radial shaft break occurring alongside a disruption of the distal radioulnar joint (DRUJ).
• Axial loading through the wrist during a fall on an outstretched, pronated forearm is the usual mechanism.
• A comparison of Monteggia vs Galeazzi fractures shows the former affects the proximal ulna, while the latter involves the distal radial shaft with disruption of the distal radioulnar joint.
• Clinical signs include wrist pain and deformity, painful and limited rotation, and possible prominence of the ulnar head.
• Diagnosis relies on forearm and wrist radiographs with careful assessment for DRUJ widening, subluxation, or instability.
• Treatment in adults almost always requires radial open reduction and internal fixation and, when needed, stabilization of the DRUJ to prevent chronic wrist pain and stiffness. In children, closed reduction and casting are often effective.