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Technique Spotlight : ORIF of Galeazzi Fracture-Dislocations
Indications
The decision between surgical and nonsurgical management is largely guided by patient age. In children, closed reduction and casting is the mainstay of treatment if an adequate reduction of both the radius fracture and the distal radioulnar joint (DRUJ) dislocation can be maintained. In adults, a fracture of the radial shaft with concomitant DRUJ dislocation has been termed “a fracture of necessity,” referring to the necessity for surgical treatment of all such fractures in order to obtain adequate outcomes. Multiple series , have reported on nonoperative treatment with closed reduction and immobilization of Galeazzi fractures in adults with nearly uniform poor results. For this reason, open reduction and internal fixation is the standard of care for adults.
Preoperative Evaluation
Physical examination will demonstrate swelling, deformity, and tenderness at the forearm. The ulnar head may be prominent in the dorsal or volar soft tissues. A detailed neurovascular evaluation should be performed, although neurovascular injuries associated with this fracture are rare. Suspicion for DRUJ dislocation should be high with all radial shaft fractures. , The wrist should be palpated for prominence of the ulnar head and tenderness at the DRUJ. Radiographic evaluation should include posteroanterior (PA) and lateral views of the forearm, wrist, and elbow. The radius may appear shortened and there may be widening of the DRUJ that is best seen on the PA radiograph ( Fig. 66.1 ). The lateral radiograph is best to visualize whether the ulnar head is displaced volarly, or more commonly, dorsally. Radiographs should also be scrutinized for an ulnar styloid fracture. Cross-sectional imaging is typically not necessary but may be used to evaluate fracture comminution or joint incongruity. The utilization of magnetic resonance imaging (MRI) to evaluate the triangular fibrocartilage complex (TFCC) has not been studied in the setting of Galeazzi fracture-dislocations and the authors do not typically obtain an MRI. While radiographic parameters are not diagnostic for DRUJ instability, the following findings should raise suspicion for a Galeazzi injury and prompt further evaluation of the DRUJ at the time of surgery: radial shaft fractures within 7.5 cm of the lunate facet, 5 mm of radial shortening, widening of the DRUJ, concomitant ulnar styloid base fractures, and ulnar head dislocation.
Positioning
The operation can be performed under regional or general anesthesia. The patient is placed supine on an operating table with the arm abducted onto a hand table. A well-padded tourniquet is applied above the elbow. A fluoroscopy unit is typically brought into the surgical field from the head of the table, with the primary surgeon positioned in the patient’s axilla and the assistant on the opposite side of the hand table.
Equipment
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