Background

A Galeazzi fracture refers to a specific type of forearm fracture that involves both the radius bone in the forearm and the dislocation of the distal radioulnar joint (DRUJ). This injury is named after the Italian orthopedic surgeon Riccardo Galeazzi, who extensively studied and described it.

Anatomy: The forearm consists of two long bones: the radius and the ulna. The radius is on the thumb side (radial side), and the ulna is on the little finger side (ulnar side). The distal radioulnar joint (DRUJ) is the joint between the radius and ulna at the wrist.

Mechanism of Injury: The force applied to the forearm can cause a fracture of the radius, often at the junction of the middle and distal thirds, and a disruption of the distal radioulnar joint.

Characteristics of Galeazzi Fracture: The fracture involves the radius, usually at the junction of the middle and distal thirds. The dislocation of the distal radioulnar joint is a crucial feature. The ulna bone may be intact or have a fracture of its own.

Clinical Presentation: Patients with a Galeazzi fracture may present with pain, swelling, and deformity in the forearm. There may be limited or painful rotation of the forearm. Clinical examination and imaging, such as X-rays, are essential for diagnosis.

Epidemiology

Incidence: Galeazzi fractures account for approximately 3-7% of all forearm fractures.

Age Distribution:

These fractures can occur across different age groups, including pediatric and adult populations.

In pediatric cases, Galeazzi fractures may result from falls or sports-related injuries.

In adults, higher energy trauma, such as motor vehicle accidents or falls from height, may be associated with Galeazzi fractures.

• Gender Distribution: There is a tendency for Galeazzi fractures to be more common in males than females.
• Unilateral vs. Bilateral: Most Galeazzi fractures are unilateral (affecting one arm), but bilateral Galeazzi fractures can occur. However, bilateral cases are quite rare.
• Mechanism of Injury: Forearm trauma or falls on an outstretched hand are the most common causes of galeazzi fractures. High-energy trauma may contribute to the occurrence of Galeazzi fractures.
• Prevalence in Clinical Practice: The relative rarity of Galeazzi fractures means that they might be underdiagnosed or misdiagnosed initially, as the clinical presentation can vary, and the fractures may only sometimes be immediately apparent on examination.

Anatomy

Pathophysiology

The weight of the hand and the thumb extensors, pronator quadratus, and brachioradialis are among the deforming forces in a Galeazzi fracture. Plaster immobilization cannot control the deforming muscular and soft tissue injuries associated with this fracture.

Etiology

The etiology of a Galeazzi fracture involves traumatic events that lead to a specific pattern of injury affecting the forearm. Common causes include falls onto an outstretched hand, direct blows to the forearm, and accidents involving axial loading and rotational forces.

Higher energy trauma, such as motor vehicle accidents, sports injuries, or industrial accidents, is often associated with Galeazzi fractures. These fractures can occur in individuals of different age groups, with a tendency to be more common in males than females.

Genetics

Prognostic Factors

Timing of Diagnosis and Treatment: Early and accurate diagnosis, followed by prompt and appropriate treatment, is crucial for a favorable prognosis.

Fracture and Dislocation Characteristics: The specific characteristics of the radial shaft fracture, such as the degree of displacement and comminution, can impact prognosis. The direction and extent of dislocation of the distal radioulnar joint also play a role in determining outcomes.

Soft Tissue Injuries: Associated soft tissue injuries, such as ligamentous or joint capsule damage around the DRUJ, may influence the prognosis. The extent of soft tissue involvement can affect joint stability and long-term function.

Age of the Patient: The age of the patient can impact healing and recovery. Younger individuals may have a better capacity for bone healing, but older individuals may have additional considerations related to bone density and overall health.

Quality of Reduction and Fixation: The quality of the reduction (realigning the fractured bone) and fixation (stabilizing the fracture with hardware) during surgical intervention is crucial. Achieving anatomical alignment and stable fixation is associated with better outcomes.

Rehabilitation and Physiotherapy: Adherence to and effectiveness of rehabilitation and physiotherapy play a significant role in the prognosis. Early mobilization, range of motion exercises, and strengthening protocols contribute to functional recovery.

Patient Compliance: Patient compliance with postoperative instructions, including limitations on activities and rehabilitation exercises, is important for a successful outcome.

Complications: The development of complications, such as nonunion, malunion, or postoperative infections, can negatively impact prognosis.

Timely identification and management of complications are crucial for optimal outcomes.

Occupational and Lifestyle Factors: The patient’s occupation and lifestyle may influence the prognosis significantly if these factors impact adherence to treatment plans and rehabilitation.

Associated Injuries: The presence of additional injuries, especially in polytrauma scenarios, may complicate the overall prognosis.

Clinical History

Age Group:

Pediatric Population:  In children, Galeazzi fractures may result from falls or sports-related injuries. Swelling, pain, and limited forearm movement may be observed.

Adult Population: Galeazzi fractures in adults often occur due to higher energy trauma, such as motor vehicle accidents or falls from height. Adults may present with significant pain, deformity, and difficulty in rotating the forearm. Soft tissue injuries around the distal radioulnar joint may contribute to the clinical presentation.

Physical Examination

Inspection: Observe for any visible deformity, swelling, or bruising in the forearm. Note the alignment of the bones, especially looking for any angular deformities or rotational malalignment.

Palpation: Palpate along the entire length of the radius, assessing for tenderness, swelling, or crepitus. Palpate the distal radioulnar joint (DRUJ) for tenderness and any step-off deformities.

Range of Motion (ROM): Assess the range of motion in both the affected and unaffected forearms. Evaluate pronation and supination of the forearm, paying attention to any restrictions, pain, or abnormal movement.

Rotation and Supination-Pronation Test: Perform the “pivot shift” or supination-pronation test to assess the stability of the DRUJ. The test involves passively rotating the forearm and observing for any subluxation or instability at the DRUJ.

Distal Neurovascular Examination: Assess distal neurovascular status by checking the radial and ulnar pulses. Evaluate sensation in the fingers and assess for any signs of neurovascular compromise.

Grip Strength: Evaluate grip strength in both hands, comparing the affected side to the unaffected side. Decreased grip strength on the affected side may indicate functional impairment.

Special Tests: Perform the “ballottement” test, involving compressing the radius proximally and distally to assess for instability. The “DRUJ stress test” can be performed to assess the stability of the distal radioulnar joint.

Functional Assessment: Assess the patient’s ability to perform activities of daily living that involve forearm rotation and grip strength. Observe for any pain or limitations during functional movements.

Age group

Associated comorbidity

High-Energy Trauma: Galeazzi fractures are often associated with high-energy trauma, which may involve activities like motorcycling, sports, or industrial work. The severity of the injury is often proportional to the energy involved, leading to more pronounced symptoms.

Osteoporosis or Bone Health Issues: Individuals with compromised bone health, such as osteoporosis, may be more prone to fractures. Fractures may occur with less force, and the risk of complications, such as delayed healing, may increase.

Associated activity

Acute Trauma: Galeazzi fractures are often the result of acute traumatic events. Immediate pain, swelling, and deformity may be evident, requiring prompt medical attention.

Delayed Presentation: In some cases, patients may delay seeking medical care, especially if the fracture is not immediately apparent. Chronic pain, deformity, and functional limitations may be more prominent in delayed presentations.

Complications and Chronic Cases: Complications such as nonunion or malunion may result in chronic symptoms. Persistent pain, joint instability, and functional impairment may be observed in cases with complications.

Acuity of presentation

Differential Diagnoses

Monteggia Fracture-Dislocation: This is a fracture of the proximal ulna with dislocation of the radial head. It is important to differentiate between Galeazzi and Monteggia fractures because they both involve the forearm but at different locations.

Isolated Radius Fracture: In some cases, a fracture of the radius may occur without dislocation of the distal radioulnar joint. This should be considered in the differential diagnosis.

Distal Radioulnar Joint (DRUJ) Dislocation: Isolated dislocation of the DRUJ without an associated radius fracture can occur.

Wrist Sprains or Ligament Injuries: Injuries to the ligaments around the wrist, especially those stabilizing the distal radioulnar joint, can cause symptoms similar to Galeazzi fractures.

Radial Head Fracture: Fractures of the radial head may present with pain and limitation of forearm rotation. This condition needs to be considered, especially if there is no fracture of the radius.

Triangular Fibrocartilage Complex (TFCC) Injury: Damage to the TFCC, a complex structure in the wrist that stabilizes the DRUJ, can mimic symptoms of a Galeazzi fracture.

Wrist Dislocations: Dislocations at other joints within the wrist can present with deformity and pain.

Soft Tissue Injuries: Soft tissue injuries, such as muscle strains and contusions, can cause pain and swelling in the forearm.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

The treatment of Galeazzi fractures involves addressing both the fracture of the radius and the dislocation of the distal radioulnar joint (DRUJ).

Emergency Management:

Stabilize the limb and provide pain management.

Apply a splint or some form of temporary immobilization to prevent further displacement of the fracture and reduce pain.

Imaging Studies:

Obtain X-rays of the forearm, including anteroposterior and lateral views, to assess the extent and characteristics of the fracture.

Closed Reduction:

Attempt closed reduction of the radius fracture, if possible, to restore normal alignment. This may involve manipulating the fracture fragments back into place without surgical intervention.

Open Reduction and Internal Fixation (ORIF):

If closed reduction is unsuccessful or if there is significant displacement, open reduction and internal fixation may be necessary. This involves surgically exposing the fracture site, realigning the fractured bones, and securing them with plates, screws, or other fixation devices.

Management of Distal Radioulnar Joint (DRUJ) Dislocation:

The dislocation of the DRUJ needs to be addressed. This may involve closed reduction and in some cases, open reduction with ligament repair or reconstruction.

Postoperative Immobilization:

After surgical intervention, the patient may be placed in a cast or splint to immobilize the forearm and allow for proper healing. The duration of immobilization depends on the specific fracture pattern and the stability achieved with fixation.

Physical Therapy:

Physical therapy is crucial for rehabilitation. It helps in regaining the range of motion, strength, and function of the forearm and wrist. The rehabilitation program is typically tailored to the individual patient’s needs and the specific nature of the injury.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-a-non-pharmacological-approach-for-the-treatment-of-galeazzi-fracture

• Physical Therapy: It is a key component of rehabilitation. Therapists can design exercises to improve range of motion, strength, and flexibility in the affected forearm and wrist. Exercises may include gentle stretching, strengthening exercises, and functional activities to restore normal movement patterns. 
• Occupational Therapy: Occupational therapists can assist in activities of daily living (ADLs) and help patients adapt to using their hands and arms during the recovery period. This may involve teaching adaptive techniques and providing assistive devices to maintain independence. 
• Cryotherapy: Cold therapy or cryotherapy can help reduce pain and swelling. Applying ice packs to the affected area in the early stages after surgery or injury can have a vasoconstrictive effect, minimizing inflammation and providing pain relief. 
• Heat Therapy: Heat therapy can be beneficial in promoting blood flow, reducing muscle tension, and relieving pain. Warm compresses or heat packs may be used judiciously, particularly during rehabilitation exercises. 
• Transcutaneous Electrical Nerve Stimulation (TENS): It involves the use of low-voltage electrical currents to stimulate nerves for therapeutic purposes. It may be used for pain management in some cases. 
• Joint Protection Techniques: Educating patients on joint protection techniques can help prevent further stress on the injured area during daily activities. This may involve modifying how certain tasks are performed to minimize strain on the healing structures. 
• Activity Modification: Advising patients on modifying their activities to avoid excessive stress on the healing fracture is crucial. This may include avoiding heavy lifting, repetitive motions, or activities that could jeopardize the stability of the fixation. 
• Psychosocial Support: Coping with a Galeazzi fracture and its treatment can be mentally and emotionally challenging. Providing psychosocial support through counseling or support groups can contribute to the overall well-being of the patient. 

Role of NSAIDs in the treatment of Galeazzi fracture

The primary treatment for a Galeazzi fracture typically involves surgical intervention, such as open reduction and internal fixation (ORIF), to address the fractured radius and restore the distal radioulnar joint (DRUJ).

In the postoperative period and during the rehabilitation process, pharmaceutical agents may be administered to manage pain, prevent infection, and support the healing process. NSAIDs are known for their analgesic (pain-relieving) properties. They can help alleviate pain associated with Galeazzi fractures, both in the postoperative period after surgical intervention and during the recovery phase. 

While NSAIDs can be beneficial, their use should be approached with caution, especially in certain patient populations. Individuals with a history of gastrointestinal issues, kidney problems, or bleeding disorders may not be suitable candidates for prolonged NSAID use. 

Role of Bone health supplements in the treatment of Galeazzi fracture

Bone health supplements can play a supportive role in the treatment of Galeazzi fractures by promoting bone healing and overall skeletal health. The most common bone health supplements include calcium and vitamin D. Here’s a closer look at their roles: 

Calcium: 

Calcium is a vital mineral that constitutes a significant portion of bone tissue. It plays a crucial role in bone formation, mineralization, and overall skeletal integrity. 

In cases of fractures, including Galeazzi fractures, providing adequate calcium is essential for optimal bone healing. Calcium supplements may be recommended, especially if there are concerns about the patient’s dietary intake or absorption. 

Vitamin D: 

Vitamin D is essential for the absorption of calcium from the gastrointestinal tract. It also plays a crucial role in bone mineralization and the regulation of calcium levels in the blood. 

Vitamin D deficiency can impair calcium absorption and negatively impact bone health. Patients with limited sun exposure, which is a natural source of vitamin D, or those with malabsorption issues may be prescribed vitamin D supplements to support bone healing. 

role-of-open-reduction-and-internal-fixation-orif-procedure-in-treating-galeazzi-fracture

Open Reduction and Internal Fixation (ORIF) is a standard surgical procedure used in the treatment of Galeazzi fractures. A Galeazzi fracture involves a fracture of the radius bone in the forearm along with a dislocation of the distal radioulnar joint (DRUJ). Here’s how ORIF is employed in the treatment of Galeazzi fractures: 

Indications for ORIF in Galeazzi Fractures: 

• Fracture Severity: Galeazzi fractures with significant displacement or comminution (broken into several pieces) may require surgical intervention. 
• Dislocation of Distal Radioulnar Joint (DRUJ): The presence of dislocation at the DRUJ is a common indication for surgical intervention to restore joint stability. 
• Intra-Articular Involvement: If the fracture extends into the joint surface, surgical fixation may be necessary to achieve anatomic alignment and prevent long-term joint issues. 

Steps Involved in ORIF for Galeazzi Fractures: 

• Anesthesia: The procedure is typically performed under general anesthesia, although regional anesthesia may also be an option. 
• Incision: A surgical incision is made to access the fractured radius and the dislocated DRUJ. The length and location of the incision depend on the specifics of the fracture and the surgeon’s approach. 

• Fracture Reduction: The fractured ends of the radius are carefully realigned to restore the normal anatomy of the bone. This may involve manipulating the fragments into the correct position. 
• Internal Fixation: Internal fixation devices such as plates, screws, or rods are used to stabilize the fractured bones. The choice of fixation method depends on the fracture pattern and the surgeon’s preference. 
• Addressing Distal Radioulnar Joint (DRUJ): The surgeon addresses the dislocation of the DRUJ, restoring proper alignment and stability to the joint. 
• Closure: The incision is closed with sutures or other closure methods, and a sterile dressing is applied. 
• Immobilization: Following the procedure, the patient’s forearm may be immobilized using a cast or splint to protect the surgical site and promote healing. 

Postoperative Care: 

• Physical Therapy: Rehabilitation, including physical therapy, is a crucial component of the postoperative care plan. Physical therapists work with the patient to restore range of motion, strength, and functionality. 
• Follow-up Imaging: Periodic imaging, such as X-rays, is conducted to monitor the healing process and assess the stability of the internal fixation. 
• Cast/Splint Removal: The cast or splint may be removed after a certain period, depending on the surgeon’s recommendations. 

role-of-restoration-of-distal-radioulnar-joint-druj-for-the-treatment-of-galeazzi-fracture

Restoration of the Distal Radioulnar Joint (DRUJ) is a crucial aspect of the treatment of Galeazzi fractures. A Galeazzi fracture involves a fracture of the radius bone in the forearm along with a dislocation of the DRUJ. The proper alignment and stability of the DRUJ are essential for overall forearm function. Here’s the role of restoring the DRUJ in the treatment of Galeazzi fractures: 

Anatomical Alignment: The DRUJ is a pivot joint that allows for rotational movement of the forearm. Restoring the anatomical alignment of the DRUJ is crucial for maintaining normal forearm function. Proper alignment ensures the stability of the DRUJ, preventing issues such as instability, pain, and limited range of motion. 

Functional Integrity: The DRUJ is a key component in the rotation of the forearm. Restoring its function allows for the normal rotational movement of the forearm, essential for various daily activities. 

Prevention of Long-Term Complications: 

• Chronic Instability: If the dislocation of the DRUJ is not addressed and restored during treatment, it can lead to chronic instability, affecting the patient’s ability to perform tasks that involve forearm rotation. 
• Joint Degeneration: Chronic dislocation or instability can contribute to joint degeneration over time, leading to arthritis and other long-term complications. 

use-of-phases-in-managing-galeazzi-fracture

The management of Galeazzi fractures typically involves different phases, each addressing specific aspects of treatment, from initial assessment to long-term rehabilitation. These phases are essential for a comprehensive and practical approach to managing this type of fracture. Here are the general phases in managing a Galeazzi fracture: 

Acute Phase: 

Initial Assessment: 

• Evaluate the patient’s overall condition, including potential associated injuries. 
• Conduct a thorough physical examination, paying attention to the forearm, wrist, and surrounding structures. 
• Obtain imaging studies, such as X-rays, to assess the nature and extent of the Galeazzi fracture. 

Emergency Treatment: 

• Stabilize the patient and address any life-threatening conditions. 
• Immobilize the forearm to prevent further injury and pain. 
• Administer pain management as needed. 

Surgical Intervention: 

Open Reduction and Internal Fixation (ORIF): 

• Evaluate the need for surgical intervention based on fracture characteristics, including displacement, comminution, and involvement of the distal radioulnar joint (DRUJ). 
• Perform ORIF to anatomically align and stabilize the fractured radius and restore the DRUJ. 
• Internal fixation devices (plates, screws, or rods) are utilized to maintain the alignment. 

Addressing Distal Radioulnar Joint (DRUJ): 

• Special attention is given to the restoration of the DRUJ during surgery. 
• Internal fixation or joint-specific procedures may be employed to achieve stability. 

Postoperative Phase: 

Immobilization: 

• Apply a cast or splint to immobilize the forearm and protect the surgical site. 
• Prevent movement that may disrupt the healing process. 

Pain Management and Monitoring: 

• Manage postoperative pain with appropriate medications. 
• Monitor the patient for signs of complications, including infection or impaired wound healing. 

Early Rehabilitation Phase: 

Early Range of Motion (ROM): 

• Initiate controlled and guided range of motion exercises under the supervision of a physical therapist. 
• Focus on gentle movements to prevent stiffness and promote joint mobility. 

Strength Training: 

• Begin progressive strength training exercises for the forearm, wrist, and associated muscles. 
• Gradually increase the intensity of exercises based on the patient’s tolerance. 

Intermediate Rehabilitation Phase: 

Functional Activities: 

• Incorporate functional activities into the rehabilitation plan to improve coordination and dexterity. 
• Emphasize activities that mimic daily tasks. 

Continued Strength and Mobility Training: 

• Progress strength and mobility exercises to improve overall function. 
• Address any residual limitations in range of motion or strength. 

Advanced Rehabilitation Phase: 

Sport or Occupation-Specific Training: 

• Tailor the rehabilitation program to the patient’s specific activities, whether related to sports or occupational tasks. 
• Ensure that the patient can safely and effectively resume normal activities. 

Long-Term Monitoring: 

• Periodic follow-up appointments to monitor the patient’s progress and address any ongoing concerns. 
• Assess the stability of the DRUJ and the overall functionality of the forearm. 

Medication

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References

Smith Fracture Review:ncbi.nlm.nih

Galeazzi Fractures:ncbi.nlm.nih