Galeazzi Fracture Research Articles

A Historical Report on Riccardo Galeazzi and the Management of Galeazzi Fractures

Fracture of the shaft of the radius associated with a dislocation of the distal radioulnar joint is an uncommon injury. In 1934, Riccardo Galeazzi of Milan reported his experience with the management of 18 such cases before the Lombard Surgical Society and subsequently received the eponym for this injury. Galeazzi was one of Italy's pioneering orthopedic surgeons, with an extensive bibliography that included nearly 150 publications. This article examines the evolution of management of the Galeazzi fracture and sheds light on this notable physician's life.

Combined elbow fracture-dislocation and Galeazzi fracture in an adult: a case report and review of the literature

Combined elbow fracture-dislocation and Galeazzi fracture in an adult: a case report and review of the literature

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.

Galeazzi Lesions in Children and Adolescents: Treatment and Outcome

A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radioulnar joint. Treatment in children and adolescents is usually possible with closed reduction and casting. The objective of this retrospectively designed study was to describe all Galeazzi lesions treated at our department during a 3-year period. One hundred ninety-eight patients with displaced fractures of the radius alone or both bones of the forearm were reviewed. In 26 (13%) cases, a Galeazzi lesion was found and these patients formed the study group. Outcome was assessed using the Gartland-Werley score. Eight of 26 (31%) fractures were recognized initially and classified as a Galeazzi lesion. Casting after fracture reduction was possible in 22 patients. Thirteen patients were treated with immobilization in a below-elbow cast and nine with an above-elbow cast. Four patients were treated operatively. The results were excellent in 23 cases and good in three cases. In cases of distal forearm fractures, a possible Galeazzi lesion should be considered. However, proper reduction of the radius with concomitant reduction of the distal radioulnar joint and cast immobilization provides good to excellent outcome even if the Galeazzi lesion is primarily not recognized. Level IV, therapeutic study.

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.

Arthroscopic Mobilization for Contracture of the Wrist

We evaluated the clinical efficacy of arthroscopic mobilization of the wrist for release of persistent traumatic contracture. We retrospectively reviewed 11 consecutive patients who had undergone arthroscopic mobilization after trauma. Patients included 9 men and 2 women who ranged in age from 16 to 65 years (mean, 40 years). Injuries causing contracture included 8 fractures of the distal radius, 1 Galeazzi fracture, 1 perilunate dislocation, and 1 carpal bone contusion. A single radiocarpal septum extended from the proximal fibrocartilage of the scapholunate ligament to the midradial ridge in all but 1 patient, in whom multiple fibrous bands bridged the radiocarpal joint. Arthroscopy disclosed 3 types of radiocarpal septum-a single fibromembranous structure that completely divided the joint (type A) in 9 cases, a membranous structure with a fenestration that partially divided the joint (type B) in 1 case, and multiple bands that completely divided the joint (type C); the latter situation occurred in the last patient described earlier. Preoperatively, the arc of motion averaged 76 degrees compared with an average of 98 degrees . Postoperatively, a 22 degrees increase was noted. Arthroscopic release of a radiocarpal septum was effective in improving range of wrist motion in patients with this finding. Level IV, therapeutic case series.

Galeazzi Fracture Nonunion Treated with a Free Vascularized Corticoperiosteal Graft

Galeazzi fracture is an unstable radial shaft fracture accompanied by injury to the distal radioulnar joint (DRUJ) and interosseous membrane.[1] It accounts for 3 to 7 percent of all forearm fractures.[2] For the treatment of Galeazzi fracture, open reduction and rigid internal fixation have been recommended because most patients treated by closed reduction have an unsatisfactory outcome.[1] [3] However, there have been reports of nonunion of the radius despite rigid internal fixation with a plate.[4] [5] Galeazzi fracture nonunion is an uncommon occurrence, but its management is challenging. Therefore, we have developed a new method for the management of Galeazzi fracture nonunion with a hybrid bone graft consisting of a free vascularized corticoperiosteal graft and a corticocancellous inlay bone graft.

Delayed diagnosis of a Galeazzi fracture—A pain in the wrist

A 23-year-old right-handed male presented to the emergency department with a painful right wrist having previously punched an opponent’s elbow during an amateur boxing match. Examination in the Emergency Department demonstrated diffuse tenderness around the anatomical snuff box with limited range of movement at the radio-carpal joints. No pain or tenderness was elicited proximal to the wrist. Radiographs demonstrated no obvious abnormality (Fig. 1). Repeat examination and radiographs of the wrist at fracture clinic the following day revealed no change in the patient’s signs or symptoms. No tenderness was elicited at proximal to the wrist. The patient was diagnosed with a suspected scaphoid fracture and treated with a scaphoid plaster. Following review at 2 weeks the patient still complained tenderness of the anatomical snuff box and at no point complained of pain proximal to his wrist joint. Further radiograph examination showed no evidence of scaphoid fracture. Due to continuing symptoms a bone scan was arranged which was performed 3 weeks

Isolated Radial Shaft Fractures Are More Common Than Galeazzi Fractures

In contrast to isolated diaphyseal fractures of the ulna (so-called night-stick fractures), isolated fractures of the radial diaphysis generally are expected to have associated injury of the distal radioulnar joint (DRUJ), the so-called Galeazzi fracture. This study retrospectively reviewed isolated fractures of the radial diaphysis in a large cohort of patients to determine how often such fractures occur without DRUJ injury Thirty-six patients with fracture of the radius without fracture of the ulna were followed up for at least 6 months after injury. Injury of the DRUJ was defined as more than 5 mm of ulnar-positive variance on radiographs taken before any manipulative or surgical reduction. All of the fractures were treated with plate and screw fixation (8 with autogenous bone grafting) and all healed. Patients with DRUJ injury had either temporary pinning or immobilization of the DRUJ or surgical fixation of a large ulnar styloid fracture. Patients without DRUJ injury were mobilized within 2 weeks. Nine patients had dislocation of the DRUJ, 4 with large ulnar styloid fractures. Among the remaining 27 patients 1 had displacement of the proximal radioulnar joint noted after surgery, leading to a secondary procedure for radial head resection. The functional results were satisfactory or excellent in all but 2 patients with functional limitations related to central nervous system injury. No patient had DRUJ dysfunction at the final follow-up evaluation. Isolated fractures of the radial diaphysis are more common than true Galeazzi fractures. Surgeons should take great care not to overlook injury to the distal or proximal radioulnar joint in association with isolated diaphyseal fractures of the radius; however, fractures without identifiable radioulnar disruption can be treated without specific treatment of the DRUJ and with immediate mobilization. Therapeutic, Level IV.

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

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

‘AO’ OR EPONYMS: THE CLASSIFICATION OF WRIST FRACTURES

Abraham Colles had the good fortune to describe the most common fracture about the wrist but, because its description was published in a provincial journal, it received little attention and was almost never referred to in his lifetime. The same can be said of Claude Pouteau who described the same fracture in another lesser-known medical journal. Robert Smith described the fracture that bears his name in 1847 although it had already been described by Jean-Gaspar-Blaise Goyrand some years before. Galeazzi's fracture had been described nearly 90 years earlier by Sir Astley Cooper and is also known as Dupuytren's and Piedmont fracture. To add to the conflicting nomenclature it is sometimes not clear whether a Smith's II fracture is a Barton's fracture or a reversed Barton's fracture. In the presence of all of this confusion it is not surprising that a Swiss group, Arbeitsgemeinschaft für Osteosynthesefragen, has classified wrist fractures into groups of As, Bs and Cs.

Die Unterarmschaftfraktur im Kindesalter

Fractures of the forearm in children are quite frequent injuries, treated in emergency rooms. Most of them occur during leisure or sport activities. Most cases are monotraumatic. The diagnosis can be made by a conventional x-ray examination of the forearm in two planes. It is possible to differentiate between stable fractures (greenstick fractures) and unstable (dislocated) fractures. The first-line therapy for stable fractures or fractures which can be reduced anatomically correctly, is the conservative procedure using a long arm cast. Axial dislocation up to 20 degrees (age <5 years) or up to 10 degrees (age >5 years) can be accepted. Special cases, such as Monteggia or Galeazzi fractures, must be considered. Unstable fractures have to be reduced during surgical stand-by. The state of the art in surgical therapy is intramedullary nailing with titanium elastic nails. Open fractures and fractures with severe soft tissue injuries can be treated with external fixation. Osteosynthesis with plates should only be used for special indications. By following therapeutic principles, a successful outcome can be achieved and later complications are rare.

Galeazzi fractures in adults

Galeazzi fractures are not uncommon. They frequently result from falls with forced hyperpronation of the forearm. They are potentially unstable because of certain destabilizing factors at the wrist. Early recognition is essential, as is early operative xation of the radius in adults. This paper reviews the English language literature and current knowledge of Galeazzi fractures in adults.

A biomechanical evaluation of lateral plating of distal radial shaft fractures

Purpose In this ex vivo biomechanical study we compared the maximum anterior/posterior bending moment, maximum torque, torsional stiffness, and twist angle at failure of distal radial shaft (Galeazzi) fractures stabilized with lateral plating (LP) and anterior plating (AP) and subjected to 4-point anterior/posterior bending and torsion. Methods Simulated fractures (oblique osteotomy between the middle and distal thirds of each radius) were created in 21 pairs of fresh, unembalmed, cadaver radii. One radius from each pair was stabilized with AP (n = 21); the contralateral radius was stabilized with LP (n = 21). Eleven pairs of specimens were tested to failure in torsion; the remaining 10 pairs were tested to failure in 4-point anterior/posterior bending. Differences between plating groups were checked for significance using paired t-tests. Results AP fixation was stronger in torsion (12.8 ± 5.6 N-m) and anterior/posterior bending (40.1 ± 25.7 N-m) than LP fixation (10.7 ± 5.6 N-m and 36.0 ± 30.5 N-m, respectively), although the differences were not significant. Similarly there was no significant difference in twist angle at failure (29° ± 13° vs 23° ± 10°) or in torsional stiffness (0.6 ± 0.2 N-m/° vs 0. 6 ± 0.2 N-m/°) between AP and LP fixations, respectively. Conclusions Because LP fixation was not mechanically superior to AP fixation and required additional tendon elevation and dissection of the dorsal sensory nerve and possibly of the lateral antebrachial cutaneous nerves, AP fixation appears to be the preferable treatment for Galeazzi fractures.

Treatment of Galeazzi's fracture - is the surgical revision of the distal radioulnar joint necessary?

Fractures of the radial shaft associated with disruption of the distal radioulnar joint (DRUJ) are termed as Galeazzi-fractures. In Galeazzi's fracture, the aim of treatment is restoring the congruency of the joint and the stability of the DRUJ, thus preventing a loss of pronation or supination. In this study, we included 24 patients (m = 22, f = 2) with 25 Galeazzi fractures treated between 1980 and 1998. Surgical treatment and the duration of therapy were analyzed retrospectively. The clinical and radiological results of 15 patients were followed up. Two children were treated conservatively with immobilization in an above-the-elbow plaster. 19 patients were treated surgically by rigid internal fixation with a plate approximately one week after the accident. Four patients were treated initially in a different way. In 13 cases, the distal radioulnar joint was immobilized by pinning with Kirschner wires. In ten patients, the DRUJ showed no instability. Patients with DRUJ pinning received an above the elbow plaster for six weeks, the other patients received a forearm cast for the time of wound healing. Two patients developed a pseudarthrosis following Kirschner-wire or rush-pin osteosynthesis. The consolidation of remaining fractures was regular. In two patients, the DRUJ was not completely stable after temporary fixation. The remaining patients revealed a stable DRUJ. Eight patients showed a limited pro- or supination after temporary Kirschner wire fixation of the DRUJ. The other patients did not reveal a decrease in range of motion. A stable and optimal reduction and a rigid internal osteosynthesis are requisites for healing of the radius fracture. Open reduction of the DRUJ is only indicated when soft tissue interposition prevents exact reposition. Surgical revision of the distal radioulnar joint was not necessary in our patients. Patients after Kirschner-wire fixation showed a diminished pro- or supination. To prevent Kirschner-wire failure, postoperative cast immobilization is indicated. Due to the retrospective nature of the study it is not definitely clear if Kirschner wire fixation is superior to immobilization.

ACUTE INJURIES OF THE DISTAL RADIOULNAR JOINT

Distal radioulnar joint injuries can occur in isolation or in association with distal radius fractures, Galeazzi fractures, Essex-Lopresti injuries, and both-bone forearm fractures. The authors have classified DRUJ/TFCC injuries into stable, partially unstable (subluxation), and unstable (dislocation) patterns based on the injured structures and clinical findings. Clinical findings and plain radiographs are usually sufficient to diagnose the lesion, but axial CT scans are pathognomonic. Diagnostic arthroscopy is the next test of choice to visualize stable and partially unstable lesions. Stable injuries of the DRUJ/TFCC unresponsive to conservative measures require arthroscopic debridement of the TFCC tear, along with ulnar shortening if there is ulnar-positive variance. Partially unstable injuries, on the other hand, are treated with direct arthroscopic or open repair of the TFCC tear, once again, along with ulnar shortening if ulnar-positive variance is present. Unstable injuries include simple and complex DRUJ dislocations. A simple DRUJ dislocation is easily reducible but may be stable or unstable. In complex dislocation, reduction is not possible because there is soft tissue interposition or a significant tear. After the associated injury is dealt with, treatment for complex injuries requires exploration of the DRUJ, extraction of the interposed tissue, repair of the soft tissues, and open reduction and internal fixation of the ulnar styloid fracture (if present and displaced). The early recognition and appropriate treatment of an acute DRUJ injury are critical to avoid progression to a chronic DRUJ disorder, the treatment of which is much more difficult and much less satisfying.

Anterior Interosseous Nerve Palsy Associated With Galeazzi Fracture

Galeazzi fracture is more common in adults than in children. Associated neurologic deficits are rare and easily missed at the first clinical examination. The authors describe a case of anterior interosseous nerve palsy after closed Galeazzi fracture. Conservative treatment resulted in complete return of normal nerve function, suggesting that this is a neurapraxia type of injury.

Simultaneous Scaphoid and Galeazzi Fractures.

Among wrist injuries, scaphoid fractures are second only in number to fractures of the distal radius, while Galeazzi fractures are relatively infrequent. It is rare for the two fractures to occur concomitantly. We report such a case in a 65-year-old woman.