Exclusion criteria included subjects with open distal radial physes, radius fracture involving the DRUJ, and radiocarpal dislocations. Inclusion criteria for the study were a fracture of the radius and an irreducible DRUJ dislocation. No study to date has compiled these results to ascertain the likelihood of encountering an irreducible Galeazzi fracture-dislocation either preoperatively or postoperative while possibly identifying the block to reduction requiring open reduction.Īn electronic literature search was employed via the MEDLINE database, OVID database, and PubMed database (1950 through October 2016) using the search terms “Galeazzi” and “fracture.” The search resulted in 124 articles. Several cases have been reported describing irreducible Galeazzi fracture-dislocations, identified either pre or postoperatively, with tendon or fracture fragments causing a block to reduction. 15, 18, 20, 26 It is difficult to determine how many of these may be the result of a block to DRUJ reduction. 9, 18, 26 Anatomic reduction with open reduction and internal fixation (ORIF) of the radius and indirect reduction of the DRUJ is the treatment however, poor results are frequent secondary to persistent DRUJ instability. Hughston reported on the poor results of nonoperative management of Galeazzi fracture-dislocations, this was later reaffirmed by Mikic. Magnetic resonance imaging can be utilized but is less diagnostic for bony abnormalities. Widening of 4 to 5 mm warrants further investigation with diagnostic studies such as computed tomography. Widening on the lateral view more than 6 mm between the dorsal cortices indicates continued instability. Widening of the radioulnar space relative to the unaffected side on the anteroposterior view indicates continued instability. Obtaining radiographs of the unaffected side is of critical importance in the diagnosis of continued DRUJ instability. 4Īfter closed or open reduction, radiographic parameters of successful reduction mirror those used for diagnosis of DRUJ dislocations. 21 Bruckner et al further classified the DRUJ dislocation as either simple (reduces spontaneously with reduction of the radius fracture) or complex (requires open reduction to remove any block to reduction to obtain satisfactory alignment of the DRUJ). Shortening of more than 10 mm results in disruption of both the TFCC and interosseous membrane. Moore et al determined that radial shortening of more than 5 mm occurs only with disruption of the triangular fibrocartilage complex (TFCC) or interosseous membrane. 24 Radiographic signs suggesting rupture of the DRUJ include widening of the DRUJ on posteroanterior view, displacement of the ulna relative to the radius on the lateral view, fracture of the ulnar styloid base, and >5 mm of radial shortening. Rettig and Raskin classified the Galeazzi fracture-dislocation according to the radius fracture’s proximity to the DRUJ: Type I 7.5 cm. The AO classification lists the Galeazzi fracture-dislocation as 22-A2.3. There are several classifications for Galeazzi fractures. Lateral view of a left forearm demonstrating disruption of the distal radial ulnar joint. Conclusions: 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. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. 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. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. A high-energy mechanism of injury was the root cause in all cases. Results: The age range was 16 to 64 years (mean = 25 years). Methods: 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 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. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. Background: 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.
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