Galeazzi Fracture-dislocation Research Articles

Management and functional outcome of Galeazzi fracture dislocation: a single centre retrospective study

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong>Galeazzi fracture dislocation is an unstable fracture dislocation of forearm that includes fracture of distal third or fourth shaft of radius with dislocation of distal radioulnar joint. The aim of the study was to analyse the management and functional outcome of Galeazzi fracture dislocation managed with fixation of radius fracture and distal radioulnar joint stabilisation with two Kirschner wires.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong>Thirty one patients with Galeazzi fracture dislocation were managed with plate fixation for radius fracture and distal radioulnar joint stabilisation with 2 Kirschner wires. They were clinically and radiographically assessed for functional outcome as well as union, distal radioulnar joint stability and any arthrosis of the wrist joint<span lang="EN-US">.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong>Functional outcome was assessed based on disability of shoulder, arm, and hand index. 94% of the patients in our series had good to fair outcome with 6% having poor outcome.</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong>All Galeazzi fracture dislocation should be managed with plate fixation for radius fracture and Kirschner wire stabilisation of distal radioulnar joint followed by splinting for 6 weeks for best functional outcome.</p>

Galeazzi fractures: Is DRUJ instability predicted by current guidelines?

IntroductionClinically significant distal radioulnar joint (DRUJ) injuries can occur with radial shaft fractures. Several radiographic methods of diagnosis, such as radial shortening of >5mm or fracture line within 7.5cm from the lunate facet, have been proposed but not clinically validated. The purpose of this study was to compare radiographic measurements of radial shaft fractures associated with and without clinically significant DRUJ injury (i.e., true Galeazzi fracture-dislocation) in order to evaluate the predictive value of reported parameters of DRUJ injury. Patients and methodsA retrospective record and radiographic review was performed of 66 consecutive skeletally mature patients with isolated radial shaft fractures from 2004 to 2014 treated at one level 1 academic trauma center. Intraoperatively determined DRUJ instability after radial shaft fixation was used as the gold standard for diagnosis of a Galeazzi fracture-dislocation. ResultsAverage age was 34 years old (range: 18–90). By thirds, there were 10 proximal (15%), 27 middle (41%), and 29 distal (44%) fractures. 13 (20%) had an associated ulnar styloid fracture. 7 (11%) patients had DRUJ instability after radial fixation. Radial shortening averaged 4.4±5.2mm (−2.6–22), and 21 had shortening of >5mm. Twenty-six (39%) fractures were within 7.5cm of the wrist joint. Previous guidelines were only moderately accurate. Even greater shortening did not predict instability (3/7 patients with >10mm shortening had a true injury). Four out of 7 cases with instability had ulnar styloid fractures (p=0.02). Discussion and conclusionsUsing a larger data set than has historically been evaluated, previously reported radiographic guidelines are only moderately accurate. The presence of an ulnar styloid fracture can be helpful. Surgeons should be aware of these associations but rely primarily on intraoperative assessment of the DRUJ after radial fixation to determine treatment.

A Neglected Unusual Galeazi Fracture Dislocation In 12 Years Child: Management

A galeazi fracture is defined as a fracture of the shaft of the radius with dislocation of the distal radioulnar joint (DRUJ). Isolated radial shaft fractures with or without DRUJ dislocation in children are unusual in clinical practice. If there is fracture the degree of angulation is measured and accordingly managed. A 12 years boy came to the casualty department of Community Based Medical College Hospital Bangladesh (CBMCH,B) with the history of fall from bicycle on out stretcher right hand 5 years back, diagnosed to have fracture shaft of right radius. X-ray examination revealed old fracture at the junction of the middle and lower third of right radial shaft with feature of nonunion with volar angulation 30° (180-1500) and interosseous angulation 150 (180-165°). Patients was operated by open reduction and internal fixation (ORIF) of the fracture using dynamic compression plate (DCP) and screws and we corrected the angulation to near normal status and also correction of DRUJ done to its near normal anatomy. Postoperatively wound healed well and patient achieved full range of motion by three weeks. Radiologically the fixation was satisfactory and at the 6 weeks fracture was united. In conclusion, an old unusual galeazzi fracture dislocation in a child below 14 years with volar / dorsal / interosseus angulation more than 150 and rotational angulation more than 30° must be managed surgically to get near normal anatomy of bone as well as near normal range of motion.
 CBMJ 2015 January: Vol. 04 No. 01 P: 41-44

Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation.

Late rupture of extensor pollicis longus (EPL) tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP). He was managed with extensor indicis proprius (EIP) transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

A Rare Case of Fracture of Radius Associated with Dislocation of Both Distal and Proximal Radio-Ulnar Joint

Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.

Early rehabilitation in unstable bilateral Galeazzi fracture dislocation: Role of transfixing K wires

The Galeazzi fracture is a fracture of the middle to distal third of the radius associated with dislocation and/or instability of the distal radioulnar joint (DRUJ). Operative treatment followed by conventional immobilization of 6-8 weeks is usually followed by good outcome, but it takes nearly 1 year for occupational rehabilitation and most cases are associated with restricted terminal range of motion. To avoid these consequences, early commencement of rehabilitation is necessary but for that the DRUJ must be stable after radial fixation. Here, we report a case of early rehabilitation in a 36-years-old horse trainer with bilateral Galeazzi fracture dislocation where both DRUJ were unstable after fixation of radius but transfixing K wires provided the required stability needed for early mobilization. The patient had complete range of motion and occupational rehabilitation by 4 months.

Ulnar variance as a predictor of persistent instability following Galeazzi fracture-dislocations

BackgroundWe investigated the radiographic parameters that may predict distal radial ulnar joint (DRUJ) instability in surgically treated radial shaft fractures. In our clinical experience, there are no previously reported radiographic parameters that are universally predictive of DRUJ instability following radial shaft fracture.Materials and methodsFifty consecutive patients, ages 20–79 years, with unilateral radial shaft fractures and possible associated DRUJ injury were retrospectively identified over a 5-year period. Distance from radial carpal joint (RCJ) to fracture proportional to radial shaft length, ulnar variance, and ulnar styloid fractures were correlated with DRUJ instability after surgical treatment.ResultsTwenty patients had persistent DRUJ incongruence/instability following fracture fixation. As a proportion of radial length, the distance from the RCJ to the fracture line did not significantly differ between those with persistent DRUJ instability and those without (p = 0.34). The average initial ulnar variance was 5.5 mm (range 2–12 mm, SD = 3.2) in patients with DRUJ instability and 3.8 mm (range 0–11 mm, SD = 3.5) in patients without. Only 4/20 patients (20 %) with DRUJ instability had normal ulnar variance (−2 to +2 mm) versus 15/30 (50 %) patients without (p = 0.041).ConclusionIn the setting of a radial shaft fracture, ulnar variance greater or less than 2 mm was associated with a greater likelihood of DRUJ incongruence/instability following fracture fixation.

English

Abstract Introduction Double injury patterns in the form of Monteggia or Galeazzi fracture dislocation represent a spectrum of forearm injuries which are severe and usually necessitate operative intervention. Association of ulnar dislocation with proximal radioulnar disruption with fracture of the radial shaft, without dislocation of radiohumeral joint, represents a rare and unusual double injury pattern which is not classified under the Bado classification system. Although easy to identify, understanding the injury morphology ensures proper treatment. The aim of this study is to present an unusual case of Monteggia variant. Case Report A 26-year-old male presented following a road traffic accident with posterior dislocation of ulna and proximal radioulnar disruption with radial shaft fracture at the junction of proximal and middle third; radial head maintained its relation with capitellum. Valgus instability necessitating treatment could be demonstrated despite of posterolateral stability even after close reduction and fixation of radius. Conclusion This injury may be classified as an unusual variant of Monteggia fracture dislocation with emphasis on associated management of medial collateral ligament depending on the patient’s profile and fracture personality for optimal results. Introduction Double injury patterns in the form of Monteggia or Galeazzi fracture dislocation represent a spectrum of forearm injuries which are severe and usually necessitate an operative intervention. Because the forearm bones and the proximal and distal joints form a closed parallelogram, injury to one is usually accompanied by injury to the opposite limb of the parallelogram. The most common injury patterns are accompanied by either disruption of the distal radioulnar joint or radiocapitellar articulation. We report a case of ulnar dislocation with proximal radioulnar disruption and fracture of the radial shaft without dislocation of the radiohumeral joint. This double injury pattern has been infrequently reported. Although the pattern is easy to identify, understanding the injury morphology is necessary to ensure proper treatment.

Bilateral Galeazzi fracture-dislocations: a case report of early rehabilitation

A 24-year-old man had bilateral Galeazzi fracture-dislocations due to a motorcycle accident. The right radius fracture was a simple fracture and was fixed with a limited contact dynamic compression plate. The left radius fracture was a comminuted fracture and was fixed with a long locking compression plate in the bridging plate fashion while maintaining reduction with a temporary external fixator. Postoperative computed tomography under passive rotation of both forearms showed acceptable congruency of the distal radioulnar joints, and early rehabilitation of forearm rotation was started at 2 weeks after the operation. At 13-month follow-up, bone union of both fractures was achieved, and forearm motion was almost restored to normal. Moreover, no subluxation or dislocation of either distal radioulnar joint was observed.

Immobilization in Supination Versus Neutral Following Surgical Treatment of Galeazzi Fracture-Dislocations in Adults: Case Series

The goal of this study was to investigate whether immobilization in supination is necessary to prevent recurrent distal radioulnar joint (DRUJ) instability in patients older than 18 years with a Galeazzi fracture-dislocation and a stable DRUJ following open reduction and internal fixation of the radius. We performed a retrospective chart review of 10 consecutive patients who were immobilized in either supination or a neutral position following surgical treatment of a Galeazzi fracture-dislocation in which the DRUJ was noted to be stable immediately after fixation of the radius. Group 1 consisted of 5 patients who were immobilized in supination for a period of 4 weeks, and group 2 consisted of 5 patients who were immobilized in neutral for 2 weeks, followed by functional bracing. Patients were followed up for an average of 68 months (range, 26-124 mo) after surgery. No significant difference was noted between the 2 groups with respect to age, medical comorbidities (no noteworthy medical comorbidities in either group), or hand dominance. None of the patients in either group demonstrated DRUJ instability during the follow-up period or required any additional surgery. At the latest follow-up, patients in the 2 groups had comparable forearm motion. The results of the current study suggest that following open reduction and internal fixation of the radius in patients with Galeazzi fracture-dislocations and with stable DRUJs, immobilization in supination for 4 weeks does not have an advantage over immobilization in neutral for a shorter period.

Immobilization in Supination Versus Neutral Following Surgical Treatment of Galeazzi Fracture-Dislocations in Adults: Case Series

Immobilization in Supination Versus Neutral Following Surgical Treatment of Galeazzi Fracture-Dislocations in Adults: Case Series

Subacute dislocation of the elbow following Galeazzi fracture-dislocation of the radius: A case report

IntroductionThe Galeazzi fracture-dislocation was originally described by Sir Astley Cooper in 1822 but was named after Italian surgeon Ricardo Galeazzi in 1934. It is an injury classified as a radial shaft fracture with associated dislocation of the distal radioulnar joint and disruption of the forearm axis joint. The associated distal radioulnar joint injury may be purely ligamentous in nature, tearing the triangular fibrocartilaginous complex, or involve bony tissue (that is, ulnar styloid avulsions) or both. We report this case because of the rare association of posterior dislocation of the elbow along with Galeazzi fracture-dislocation. To the best of our knowledge, this has not been previously reported in the English literature.Case presentationA 26-year-old Caucasian man presented to our department after a fall from a motorbike. He sustained a closed, isolated Galeazzi fracture-dislocation of the right forearm and no associated elbow injuries, and this necessitated open reduction and internal fixation of the radius. Post-operative radiographs films were satisfactory. However, clinical and radiological evidence of ipsilateral elbow dislocation was noted at a five-week follow-up, subsequently requiring open reduction of the joint and collateral ligament repair. Our patient was noted to have full elbow and forearm function at three months.ConclusionsAlthough the Galeazzi fracture-dislocation has been classically described as involving only the distal radioulnar joint, traumatic forces can be transmitted to the elbow via the interosseous membrane of the forearm. This can lead to instability of the elbow joint. Therefore, we recommend that, in every case of forearm fracture, both elbow and wrist joints be assessed clinically as well as radiologically for subluxation or dislocation.

Treatment of diaphyseal non-unions of the ulna and radius

IntroductionNon-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation.MethodWe retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975–2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed.PatientsThe study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues.ResultsAverage follow-up time was 75 months (range 12–315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%).ConclusionOur results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

Percutaneous osteosynthesis of Galeazzi fracture-dislocation.

Background:A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radio-ulnar joint (DRUJ). The conventional surgical technique of nailing does not give enough stability and open reduction, internal fixation with the plate is associated with numerous complications. The stacked nailing for the management of these injuries provides adequate stability, maintains the relationship of the DRUJ and promotes uneventful union by closed technique. The purpose of this study is to evaluate the results of simple, user-friendly, low cost elastic stacked nailing for the management of Galeazzi fracture dislocation.Materials and Methods:We treated 22 young adults with fresh Galeazzi fracture-dislocation of the forearm, from January 2004 to January 2008, by percutaneous fixation of fracture by stacked elastic nailing at our institute. There were 19 males and three females and the age group ranged from 20-56 years (average 35 years). Surgery was performed within 48 to 72 hours under the guidance of image intensifier. Medullary cavity was filled with two elastic titanium nails having unequal lengths and diameter. One nail acts as a reduction nail and the other acts as a stabilizing nail. The results were evaluated using Mikic criteria based on union, alignment, relationship of the DRUJ, and movements at the inferior radio ulnar joint, elbow and wrist.Results:In six cases, following radiological union, nails in the radius were extracted between six to nine months after operation because of discomfort complained by the patient at site of insertion. After one year follow-up, 18 patients had excellent, four had fair results.Conclusion:Closed reduction and internal fixation of Galeazzi fracture by two elastic rods re-establishes the normal relationship of the fractured fragments and the DRUJ without repair of the ligaments. The stability is achieved by the flexibility and elasticity of the nails, crowding of the medullary canal and anchorage they gain in the radial diaphysis. Elastic nailing can produce excellent clinical results for Galeazzi fracture-dislocation. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve.

Flank swelling following abdominal trauma: an easily overlooked injury

A 56-year-old man was admitted to his local hospital following a road traffic accident. He sustained multiple injuries as a result of a high-energy head-on collision. In the emergency department, he was resuscitated according to Adult Trauma Life Support (ATLS) guidelines. Clinical examination revealed several injuries that were confirmed by plain radiography and CT from the head to pelvis: a right flail chest, a small haemopneumothorax, a complex open olecranon fracture, a Galeazzi fracture dislocation and a fracture dislocation of the right hip and acetabulum. He remained unwell for the next 4 days, mainly as a result of poor ventilatory function. The patient was then transferred to a tertiary centre for definitive treatment of his injuries, where another injury was noted. From the original CT scan (Figure 1), what was this diagnosis? At the tertiary centre, the patient was observed to have a 3 6 3 cm tender fluctuant swelling over the right posterior abdominal wall and a contusion over the anterior abdominal wall consistent with a seat belt injury. As this injury was not previously documented, a further CT of the chest, abdomen and pelvis was performed (Figure 2). Is the diagnosis more evident?

Minimally displaced distal radius fracture: think again!

Minimally displaced distal radius fractures are very commonly seen and quite easily managed with closed reduction and cast immobization. We describe a similar case which was managed in the same way. Gross dorsal angulation at the fracture site 3 months post injury lead us to retrospective review of radiographs which yielded DRUJ disruption. Missed DRUJ disruption or failure to restore it has a telling effect on the final outcome of these seemingly ‘easy’ fractures. Every distal radius fracture should be looked to see if it is a Galeazzi fracture dislocation. The stability and the need to fix the DRUJ with k wire should be assessed to avoid the series of events as in our case.

Irreducible galeazzi fracture–dislocation due to intra-articular fracture of the distal ulna

Irreducible Galeazzi fracture-dislocation is a rare injury. Structures that mechanically block the reduction are usually soft tissues. We present an irreducible case due to distal ulnar intra-articular fracture.

Ipsilateral Galeazzi and Monteggia fracture

A combined Galeazzi and Monteggia fracture dislocation is very rare and there are few reported cases in the English literature worldwide. However, the described injuries are not classical of either fracture dislocation. Both in children and in adults the reported literature does not show classical fracture types of either Galeazzi or Monteggia lesion in the same forearm. Our patient had the classical combination of both Galeazzi and Monteggia fracture in the same forearm. We have described the rare mechanism of injury and management for this injury based on a review of the literature.

Pulmonary embolism after surgical treatment of Galeazzi fracture dislocation. A case report

Pulmonary embolism after surgical treatment of Galeazzi fracture dislocation. A case report

PAEDIATRIC GALEAZZI-EQUIVALENT FRACTURE: TWO CASE REPORTS

The authors present two rare cases of a paediatric Galeazzi-equivalent fracture. In contrast to Galeazzi's fracture-dislocation in adults, an epiphyseal separation of the distal ulna occurred instead of dislocation of the distal radioulnar joint (DRUJ) or both. A precise radiographic analysis of the epiphyseal separation of the distal ulna and its anatomical reduction were keys to obtaining a good result in the treatment of paediatric Galeazzi-equivalent fracture.