Galeazzi Fracture-dislocation Research Articles

The role of arthroscopic triangular fibrocartilage complex repair in a case of bilateral Galeazzi fracture-dislocation

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

Arthroscopic Examination of the Triangular Fibrocartilage Complex in Galeazzi Injuries: Revisiting a Complex Injury

AbstractGaleazzi fracture-dislocations result from severe trauma and can lead to loss of function of the wrist and forearm if not treated appropriately. To avoid such disasters, meticulous surgical management of the injury is necessary. The current literature talks about symptomatic distal radioulnar joint injuries in Galeazzi fracture-dislocations and the various approaches to managing instability. However, unfortunately, there is a dearth of data on the true incidence of injury to the triangular fibrocartilage in the backdrop of the severity of the mechanism of Galeazzi fractures and the damage it may cause as direct inspection of the triangular fibrocartilage complex is not done routinely as a part of management of such cases. We conducted a retrospective review of six consecutive patients with Galeazzi fracture-dislocations. Wrist arthroscopy was performed in these cases, which revealed complex tears of the triangular fibrocartilage complex involving large segments of the ligament and always involving the dorsal periphery. All tears followed the same pattern of disruption of the attachments of two sides of the triangular fibrocartilage complex. We believe our findings will pave the path to further prospective studies in understanding the degree of damage in the triangular fibrocartilage in such devastating injuries and the need for meticulous arthroscopic repair.

Two-week versus four-week immobilization of stable distal radioulnar joint following surgical fixation of Galeazzi fracture-dislocations: A randomized controlled trial

BackgroundPostoperative immobilization protocols following surgical fixation of Galeazzi fracture-dislocations (GFD) in adults remain unresolved. This study aimed to compare outcomes of two different immobilization durations (two weeks versus four weeks) in terms of functional outcomes and complications. MethodsParticipants were prospectively and randomly enrolled in two-week versus four-week immobilization after plate fixation of GFD when the distal radioulnar joint (DRUJ) was reducible and stable postoperatively. Immobilization involved an above-elbow splint with the forearm in full supination. Demographic data, including age, gender, mechanism of injury, fracture characteristics, and treatment approach, were recorded. The primary outcome was the abbreviated version of the Disability of Arm, Shoulder, and Hand (DASH) scores at three months post-operation. Secondary outcomes included wrist range of motion, mean grip strength differences between injured and uninjured sides, and complications. ResultsA total of 54 participants were enrolled and randomized into two treatment groups. Demographics were similar between groups, with most participants being male, and the mean age was 35 years (range 18–65). Fractures were generally less than 10 cm. The mean DASH scores were slightly higher in the four-week immobilization group but not statistically significant (1.43 in the two-week immobilization group vs. 2.36 in the four-week immobilization group, p = 0.152). Range of motion and mean grip strength differences were similar between groups. Complication rates were also similar, with recurrent DRUJ dislocation occurring in two participants from each group. ConclusionThis study found no significant differences in functional outcomes and complications between two-week and four-week immobilization durations after plate fixation of GFD when the DRUJ was reducible and stable postoperatively. Level of evidenceTherapeutic Level I.

Anatomic and Biomechanical Study of the Forearm Interosseous Membrane, Distal Oblique Bundle, and Triangular Fibrocartilage Complex: Role in Galeazzi Fracture Dislocation

The purpose of this study was to measure distal radioulnar joint (DRUJ) dislocation and radioulnar displacement associated with sequential sectioning of the different bands of the interosseous membrane and triangular fibrocartilage complex in the simulation of a Galeazzi fracture dislocation. Twelve fresh-frozen cadaver forearms were dissected. We examined the anatomy and function of the forearm interosseous membrane. Each forearm was then mounted onto a biomechanical wrist and forearm device. In the control group, radial osteotomy was performed and the degree of DRUJ displacement with progressive loads was measured. In addition to radial osteotomy, in group 1, the central band (CB) was sectioned; in group 2, the CB, distal membranous portion of the interosseous membrane, and distal oblique bundle were sectioned; and in group 3, the CB, distal membranous portion of the interosseous membrane, distal oblique bundle, and triangular fibrocartilage complex were sectioned. The radioulnar displacement (mm) at 25 N, 50 N, and 75 N was recorded. In group 1, applying progressive loads resulted in an average DRUJ displacement of 4.3, 5.9, and 7.9 mm, respectively. In group 2, the displacement was 5.2, 5.7, and 6.9 mm, respectively. In group 3, the displacement was 6.2, 8.1, and 9.9 mm, respectively. Our study showed a correlation between increase in the load applied to the same injury and the degree of displacement (P= .001). In group 3, the degree of DRUJ displacement was statistically increased compared to the other groups (P= .04). Migration of the radius under loads implies disruption of both the CB and triangular fibrocartilage complex. The distal oblique bundle by itself does not seem to have a relevant role in radioulnar displacement at the DRUJ. This study provides insights into the interosseous membrane and stability of the DRUJ, which can contribute to a better understanding of Galeazzi fracture-dislocations.

Fracture of Galeazzi: Retrospective Study in the Department of Orthopedic Traumatology of the University Hospital of Avicenne Rabat about 18 Cases

Our retrospective study focused on 18 cases of Galeazzi fracture-dislocations collected in the Traumatology and Orthopedics department at the Avicenne University Hospital in Rabat between 2005 and 2010. The objective was to demonstrate the severity of this injury, which is still rare and often misdiagnosed as an isolated radius fracture. The mean age was 32 years with a range from 24 to 60 years, and males were predominant with a sex ratio of 5:1. The main causes were traffic accidents (56%), followed by assaults and work accidents (18%). The right side was more frequently affected (55%). Surgical treatment was performed in all cases. The outcomes, evaluated according to the MICKIC criteria, were excellent in 14 cases (82.35%). The prognosis of Galeazzi fracture depends mainly on the initial treatment of the distal radioulnar joint lesions, which require careful clinical examination and good radiological analysis for their diagnosis.

Use of 3D-printed Polycaprolactone + Hyaluronic Acid-Based Scaffold in Orthopedic Practice: Report of Two Cases

3D-printed (3DP) polycaprolactone (PCL)-based scaffolds have gained popularity in the past decade. Despite the wide utility of autografts for bone regeneration in orthopedics practice, 3DP PCL scaffolds may replace this general application. Here we present a 42-year-old patient who had glenohumeral arthritis due to rheumatoid arthritis accompanied by a Walch 3 glenoid defect, and a 19-year-old patient with neglected Galeazzi fracture–dislocation accompanied by a radius non-union. In both patients, a 3DP PCL + hyaluronic acid-based scaffold was used for bone regeneration purposes. The preliminary results showed that the 3DP PCL + hyaluronic acid scaffold provided bone regeneration and may be a promising alternative to autografting for bone regeneration in orthopedic practice.

Galeazzi Fracture-Dislocation.

A Galeazzi fracture-dislocation is defined as a distal radius fracture with disruption of the distal radioulnar joint (DRUJ). The typical mechanism of injury is a forceful axial load with forearm torsion, which is often seen in a fall on the out stretched hand (FOOSH). The diagnosis is made with radiographs of the distal forearm and the wrist. The diagnosis can often be missed because ligament disruption of the distal radioulnar joint (DRUJ) can be overlooked. Treatment in children is usually nonsurgical with closed reduction and long arm cast. Adult treatment is usually open reduction and internal fixation. Complications can result in disability and include malunion, limited range of motion of the forearm, chronic pain, DRUJ instability, and osteoarthritis.

Bilateral symmetrical pronation type of Galeazzi fracture following high-speed motor traffic crash: A case report.

Introduction and importanceBilateral Galeazzi fracture is a rare occurrence following trauma. Anatomical reduction of the fracture and the distal radioulnar joint is mandatory for a good outcome.Case presentationWe present a 24-year-old patient with bilateral Galeazzi fracture following a high-velocity motorbike accident.Clinical discussionA motorcyclist presented with bilateral painful deformed forearms following a motor traffic crash. Radiographs of bilateral forearms showed bilateral symmetrical supination type (Type II) Galeazzi fractures. He has undergone open reduction and internal fixation of the bilateral radii. Bilateral distal radioulnar joints reduced spontaneously when the fracture of the radius reduced anatomically. The reduction of the fracture and the distal radioulnar joints was confirmed by postoperative radiographs.ConclusionBilateral Galeazzi fracture is a rare entity following high-velocity injury. Disruption of the distal radial ulnar joint needs to address to achieve a good outcome. An awareness of this entity, early detection, and intervention of this condition may help to regain the full function of the forearm.

Galeazzi fracture–dislocations: Long-term prognosis of the distal radioulnar joint

The aim of the present study was to evaluate long-term functional and radiographic outcome in the distal radioulnar joint (DRUJ) for Galeazzi fracture–dislocation after anatomic reduction and rigid fixation of the radius. Fourteen patients, with an average age of 38 years, presenting with Galeazzi fracture–dislocation treated by open reduction and internal fixation (ORIF) of the radius and closed reduction of the DRUJ were retrospectively evaluated, with a minimum follow-up of 6 years. At final evaluation (mean: 8 years), the DRUJ was objectively and subjectively evaluated for range of motion (RoM), grip strength, ballottement test, pain on axial loading, function on visual analog scale (VAS) and DASH score. Radiographs and dynamic CT scans were performed to screen for DRUJ instability and/or osteoarthritis. Six of the patients had a positive comparative ballottement test, but none reported pain during the maneuver. No significant differences in RoM were found between the injured and uninjured wrist. Mean grip strength in the injured wrist was 77% of the contralateral value. Mean pain on VAS was 0.6. Mean global function on VAS was 9. Mean DASH score was 3. Dynamic CT showed no clear subluxation in any of the patients, and none showed severe articular changes. Our findings suggest that long-term clinical and radiological prognosis for the DRUJ in Galeazzi lesions is favorable when adequate closed reduction of the ulna is achieved after anatomical ORIF of the radius. Level of evidenceIV. Therapeutic case series.

The \u201cfloating ulna\u201d injury in adults: a case report, literature review and proposed injury classification

BackgroundIpsilateral Galeazzi fracture with elbow dislocation, namely the “floating ulna” injury, is a rare injury pattern. A few reports have described this type of injury and its treatment.Case presentationA 33-year-old female at 38+ weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. At the 12-month follow-up, the patient had no pain or signs of instability. Range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm.ConclusionThe “floating ulna” injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1–2 m in high-energy trauma.

Functional Outcome of Galezzi Fracture Dislocation in Adults Treated With Dynamic Compression Plate and Kirschner Wire

Introduction: Galeazzi fracture-dislocation is a complex traumatic disruption of the distal radioulnar joint (DRUJ) that is associated with lower shaft radius fracture. Galeazzi fractures are extremely unstable, and the results of nonsurgical treatment are uniformly unsatisfactory. Galeazzi fractures managed with closed modalities have unsatisfactory clinical results in most of the patients in published literature so open reduction and internal fixation with plating is the standard treatment for this fracture. Aims: The aim of this study was to evaluate the functional outcome of Galeazzi fracture dislocation. Methods: This prospective study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur, from April 2016 to March 2019. It included 35 patients of age group 19 to 49. All of the fractures in this study were treated by open reduction and internal fixation (ORIF) with 3.5 mm narrow dynamic compression plate (DCP) and cortical screws via Henrys anterior approach and distal radioulnar joint (DRUJ) stabilization was done with 1 Kirschner wire (K-wire) inserted parallel to the wrist joint. Patients were observed at 6, 10, 16 and 24 weeks and 52 weeks both radiographically and clinically. Results: In this study of 35 patients, 24 (68.57%) were males and 11 (31.43%) were females with the age range of 19 to 49 years and mean age of 35 and standard deviation (SD) of ±1.5 years. Majority of fractures were observed between 31 to 40 years of age. Most of the injuries were due to fall injury 51.42%. The average duration from time of injury to surgery was 5 days and bone grafting was not needed in any cases. The average time period for union was about 16 weeks. The most common complication seen in this study was stiffness of wrist (11.42%). Twenty four patients (68.57%) had good result, 10 patients (28.57%) had fair result and one patient (2.86%) had poor result in DASH score at final follow-up. Conclusion: Open reduction and internal fixation with plating and stabilization of distal radioulnar joint with K wire yields good to fair outcome on Disabilities of Arm, Shoulder and Hand Score.

Chronic Galeazzi Fracture-Dislocation: A Case Report.

Introduction:Galeazzi fracture-dislocation is a unique entity of forearm fractures since they involve a fracture of the radius shaft, along with the dislocation of the distal radioulnar joint, the gold standard of treatment for adults is open reduction and internal fixation with or without repair or pinning of the DRUJ.Case Report:We present a case of a 27-year-old male with a neglected Galeazzi fracture for over 2 months, the patient was treated with open reduction and internal fixation without the need of a salvage procedure and achieved excellent outcomes.Conclusion:Galeazzi fractures are not uncommon, and any forearm fracture requires complete radiographic and clinical assessment to avoid dreadful complications of delayed management.

Galeazzi Fracture Dislocations: An Illustrated Review.

Galeazzi fracture dislocations are a fracture of the distal one third of the radius shaft with a concomitant dislocation of the distal radioulnar joint (DRUJ). These injuries usually occur by axial loading on an outstretched arm with pronation or supination of the wrist which determines the angulation of the fracture. Surgical treatment has been historically by the anterior (volar) approach to the forearm with plate fixation with or without pinning of the distal radioulnar joint. Failed or inadequate treatment may lead to complications including chronic pain, malunion or instability of the DRUJ that may warrant salvage procedures.

Retrospective study of Galeazzi fractures in adults hospitalized in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia: about 45 cases

La fracture de Galeazzi est définie par l'association d'une fracture du radius et une luxation radio-ulnaire inférieure. Son diagnostic est souvent méconnu initialement. Le but de notre travail est de déterminer l'aspect épidémio-clinique des fractures luxation de Galeazzi chez l'adulte et d'apprécier les résultats fonctionnels et radiologiques de notre série. Il s'agit d'une étude rétrospective descriptive, sur une période allant de 2009 à 2018 colligée au Service d'Orthopédie du CHU Habib Bourguiba Sfax, portant sur 45 cas de fractures de Galeazzi traitées chirurgicalement. Nous avons utilisé le score de Mestdagh pour l'évaluation clinique de nos résultats. Le délai moyen de prise en charge était 5,35 jours. La synthèse du radius a été pratiquée par plaque vissée dans 39 cas et la radio-ulnaire a été embroché dans 13 cas. La consolidation a été obtenue dans un délai moyen de 10,5 semaines. Les résultats étaient excellents chez 35 patients, bon chez 3 patients, moyen chez 6 patients et mauvais chez un patient. Nous avons déploré 3 cas de sepsis sur broche et deux cas de cal vicieux. La fracture luxation de Galeazzi reste une entité sous diagnostiquée dans certains cas. Un examen dynamique peropératoire après synthèse solide du radius a permis d'avoir de bons résultats fonctionnels.

Arthroscopic reduction of an irreducible distal radioulnar joint in Galeazzi fracture-dislocation due to a fragment of the ulnar styloid: a case report

BackgroundThere are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods. Arthroscopy for the distal radioulnar joint of the wrist joint has recently been used for wrist pathology. We aim to describe the surgical procedure involved in arthroscopic reduction of irreducible Galeazzi fracture-dislocation and clinical outcome and review the literature.Case presentationWe present the case of a 26-year-old man, a professional athlete, who sustained Galeazzi fracture-dislocation during a bicycle race. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. Operative treatment was performed using a 30° oblique, 1.9-mm arthroscope. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. The metaphyseal and intra-articular fracture of the radius and the fragment of the ulnar styloid were fixed using a volar locking plate and tension band wiring technique, respectively. A daily injection of parathyroid hormone and low-intensity pulsed ultrasound were used postoperatively. The patient was asymptomatic and returned to the preinjury level of athletic activity 2 months postoperatively, and bone union of the radius and ulna was achieved without distal radioulnar joint instability 15 months postoperatively.ConclusionsLess invasive reduction of the dorsal anatomical structure enabled our patient to return early to sports. We consider arthroscopic reduction to be superior to the open surgical method in terms of evaluating interpositions; additionally, arthroscopic reduction is minimally invasive and does not need immobilization because it does not cause significant damage to the dorsal capsule and subsheath of the extensor carpi ulnaris, which comprise the triangular fibrocartilage complex.

Plating the radial shaft on the lateral surface: An outcome study

PurposePlate fixation is the gold standard for the treatment of displaced forearm shaft fractures in adults. Conventionally radial shaft fractures will be plated either on the volar surface or on the dorsal surface depending on which approach has been chosen. The lateral surface of the radius provides an even and uniformly curved area for placing a plate. It has the advantage of restoring and easy assessing the radial bow after surgery. We designed a prospective study to observe the outcome of lateral plating of radius shaft fractures. MethodsNineteen patients were included in this study performed in Government Medical College, Jammu, India. Among them, 13 had fractures of both the forearm bones and 6 had isolated radial shaft fracture. Three patients had Galeazzi fracture dislocation. Fixation was done within 36 h of injury in all using 3.5 mm limited contact dynamic compression plate or locking compression plate applied to the lateral surface of the radius. Ulna was fixed in routine manner. ResultsUnion was achieved in 18 out of 19 patients, after a mean time of 17.44 weeks. According to Anderson et al.'s criteria, 12 patients had excellent results, 5 had satisfactory and 1 had unsatisfactory result. There was one failure (nonunion). ConclusionThe outcomes including rate of union were comparable to those in the existing literature. Plating the radial shaft on the lateral surface is a viable alternative to volar or dorsal plating of the radius. Larger studies with randomized data are needed to assess whether it has any superiority over other existing techniques.

Galeazzi Fracture-Dislocation Concomitantly With Radial Head Fracture, A Case Report and Suggest the Mechanism of Production of This Rare Injury

Galeazzi Fracture-Dislocation Concomitantly With Radial Head Fracture, A Case Report and Suggest the Mechanism of Production of This Rare Injury

Short term outcome of use of locking compression plates for treatment of galeazzi fracture-dislocation using anderson & sisk score

Objective: The study focusses on short term outcomes of locking compression plating for treatment of Galeazzi fracture- dislocation using Anderson & Sisk score. Introduction: The Galeazzi fracture is an unstable fracture-dislocation of the forearm that includes a fracture of the shaft of the radius and a dislocation of the distal radio-ulnar joint (DRUJ). The goal of the treatment is an anatomic reduction and a rigid internal fixation of the radial fracture and also restoration of normal anatomy of the distal radio-ulnar joint. Methodology: A cohort of 15 patients with Galeazzi fracture-dislocation treated with locking compression plates between January 2016 to January 2017 were assessed for 6 months and final result was analysed using Anderson & Sisk score. Results: Using the Anderson & Sisk scoring system 86.66% patients (13) achieved excellent results, 6.66% patients (1) achieved satisfactory results and 6.66% patients (1) achieved unsatisfactory results.

Irreducible Galeazzi Fracture-Dislocations.

Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms "Galeazzi" and "fracture." Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

Surgical management and functional outcome of Galeazzi fracture dislocation

Surgical management and functional outcome of Galeazzi fracture dislocation