From the Guidelines
The recommended treatment for a Galeazzi fracture with Distal Radioulnar Joint (DRUJ) instability is open reduction and internal fixation (ORIF) of the radial fracture, followed by assessment and management of the DRUJ instability. This approach is based on the principle of stabilizing the radius first, which is crucial for restoring forearm function and facilitating healing of the DRUJ. Although there is no conclusive evidence to support concurrent surgical treatment of DRUJ instability in patients with surgically treated distal radius fractures, as stated in the study by 1, clinical experience and general medicine knowledge suggest that addressing both components of the injury is essential for optimal outcomes.
Key Considerations
- Anatomic reduction and rigid fixation of the radial fracture using a volar locking plate are typically the initial steps in managing a Galeazzi fracture.
- After stabilizing the radius, the DRUJ is reassessed for persistent instability.
- If DRUJ instability persists, direct repair of the triangular fibrocartilage complex (TFCC) or temporary DRUJ pinning with Kirschner wires may be necessary to ensure proper healing and prevent long-term morbidity.
Post-Surgical Management
- The arm is usually immobilized in a long arm cast or splint for approximately 2 weeks post-surgery.
- Controlled range of motion exercises can begin after the initial immobilization period, aiming to restore full forearm rotation and wrist motion.
- The Kirschner wires, if used, are typically removed after 4-6 weeks, allowing for gradual return to normal activities.
Given the complexity of Galeazzi fractures and the potential for poor outcomes with conservative management, a surgical approach that addresses both the radial fracture and DRUJ instability is generally recommended to optimize morbidity, mortality, and quality of life outcomes. The study by 1 highlights the lack of conclusive evidence regarding the timing of DRUJ instability treatment but does not negate the importance of addressing this component of the injury in the clinical management of Galeazzi fractures.
From the Research
Treatment Options for Galeazzi Fracture with DRUJ Instability
The treatment for a Galeazzi fracture with Distal Radioulnar Joint (DRUJ) instability typically involves surgical intervention. The following are some treatment options:
- Open reduction and internal fixation of the radial shaft fracture, which may be followed by supplemental wire transfixion of the DRUJ or open reduction and triangular fibrocartilage complex repair if DRUJ instability is present 2
- Anatomic reduction and rigid fixation of the radius, with intraoperative assessment of the DRUJ and further interventions based on the reducibility and postreduction stability of the DRUJ 3
- Immobilization in supination or neutral position after surgical treatment, with no significant difference in outcomes between the two positions 4
Key Considerations
When treating a Galeazzi fracture with DRUJ instability, it is essential to:
- Achieve anatomic reduction and rigid fixation of the radius to prevent chronic problems such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis 2, 3
- Assess the DRUJ intraoperatively and perform further interventions if necessary to ensure stability and prevent long-term complications 2, 3
- Consider the patient's age and medical comorbidities when selecting a treatment option, as nonsurgical management may be successful in children but typically fails in adults 3
Long-Term Prognosis
The long-term prognosis for the DRUJ in Galeazzi lesions is favorable when adequate closed reduction of the ulna is achieved after anatomical open reduction and internal fixation of the radius 5. However, it is crucial to recognize and treat DRUJ instability promptly to avoid chronic problems and ensure optimal outcomes.