Executive Editor: Chris Colton

Authors: Dominik Heim, Shai Luria, Rami Mosheiff, Yoram Weil

Forearm shaft Simple fracture of the radius, with dislocation of distal radioulnar joint (Galeazzi)

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Glossary

General considerations

22-A2.3

In a Galeazzi fracture-dislocation the radial shaft fracture is associated with a dislocation of the ulna at the distal radioulnar joint (DRUJ).

Most often, the ulnar head dislocation is posterior (dorsal), very seldom anterior (volar).

Anatomical reduction of the radial fracture usually leads to spontaneous relocation of the ulnar head. In Galeazzi fracture-dislocations, anatomical reduction and stable fixation are mandatory if accurate reduction of the ulnar head and a satisfactory outcome are to be achieved.

Once operative fixation has been completed, the surgeon must ensure the stability of the reduced ulnar head, preferably under image intensification. If the ulnar head cannot be reduced, exploration of the DRUJ is usually required. If the ulnar head is reducible, but is unstable, verify that the radial reduction is anatomical. If the radius is satisfactory, then the rotational forearm position in which the ulnar head is most stable will be the position for postoperative splinting. Transfixation of the DRUJ with one or more K-wires has been used but has to be regarded as the last resort.

Intramedullary nailing of forearm fractures is currently limited to pediatric fractures and severe multifragmentary injuries of one or both forearm bones in the presence of devastating soft-tissue damage. Pediatric fractures are not included in this module of AO Surgery Reference. Discussion of nailing in adult forearm shaft fractures is confined to multifragmentary fractures of both bones in adult AO Surgery Reference.

Nonoperative treatment
Indication summary Skill Equipment
Surgical treatment not possible Basic surgical experience, no specialized skills Basic equipment only

This is only indicated when surgical fracture treatment is impossible. A good functional result is unlikely.

External fixation
Indication summary Skill Equipment
A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources

External fixation can be indicated in severely open fractures as means of temporary fixation (with a view to later conversion to internal fixation).

ORIF - Plating
Indication summary Skill Equipment
Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources

In Galeazzi fracture-dislocations, anatomical reduction and stable fixation of the radius and stable reduction of the ulnar head are only likely to be achieved by plating. These fractures therefore present strong indications for plating.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2013-07-09