Galeazzi Fracture Dislocations

Importance of the Problem

Recognition of the Galeazzi fracture pattern is critical to successful management of these injuries. While the majority of radial shaft fractures are isolated and do not have associated instability, the DRUJ must be scrutinized for subluxation or dislocation, especially those occurring at the junction of the middle and distal third of the radius. Most true Galeazzi injuries will result in frank dislocation of the DRUJ, however, the ulnar head may demonstrate more subtle subluxation in about 20% of cases making diagnosis more difficult. While Galeazzi fracture-dislocations comprise ≤ 7% of adult forearm fractures, misidentification and inadequately treated injuries may result in ongoing DRUJ instability, restricted forearm rotational range of motion, and persistent ulnar sided wrist pain. Patients may experience limited function as well as reduced strength as a result. Additionally, the results of acute operative treatment are superior to that of nonoperative management or delayed reconstruction, particularly with regards to reduction and stability of the DRUJ.

Main Question

• In adult patients with acute Galeazzi fracture-dislocations, what is the most effective approach to management in order to restore stability and full range of motion to the distal radioulnar joint?

Current Opinion

After anatomic reduction of the radius with rigid fixation, assessment of stability of the DRUJ should be performed through a full range of pronosupination. When the DRUJ may be safely reduced and easily maintained, immobilization in a stable position is recommended. For injuries where the reduction is difficult to maintain, or stable only through a short arc of motion, pin fixation of the DRUJ is indicated. Open reduction is performed when the joint is unable to be reduced by closed means.

Finding the Evidence

We conducted a search of the Cochrane library, Medline and Embase via OVID, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). The search terms included using “Galeazzi” as a keyword and combining “radius” and “radius fracture” with “wrist injuries,” “joint dislocations,” “ulna,” “ulna fractures.” We excluded papers not published or translated into English. The reference list of included articles were also reviewed to identify additional papers not included in our initial search.

Quality of the Evidence

No Level I, II, or III evidence exists regarding adult Galeazzi fracture-dislocation management. The best available evidence included in this review are Level IV:

• 13 Case Series, 2 Small Retrospective Cohort Studies and 1 Systematic Review (of case reports).

Findings

We included comparative studies and any series reporting results in 10 or more adult patients. Sixteen studies were identified for inclusion (total 573 patients, range 10–95). Thirteen studies were case series (Level IV) of which a total of 448 patients were treated operatively and 108 patients were initially treated nonoperatively. Two of the studies included were retrospective cohort studies (Level IV) with a total of 17 patients with Galeazzi injuries. There was also one systematic review of case reports (Level IV) describing irreducible DRUJ dislocations.