What are the operative procedure steps for managing a Galeazzi fracture of the radius using open reduction and internal fixation with plating?

From the Guidelines

The operative procedure for a Galeazzi fracture involves open reduction and internal fixation (ORIF) of the radius with plating, prioritizing anatomical reduction and stable fixation to restore radial length and alignment, crucial for distal radioulnar joint (DRUJ) stability and forearm function. The steps for managing a Galeazzi fracture of the radius using ORIF with plating include:

• Beginning with appropriate anesthesia, typically general or regional block, and positioning the patient supine with the affected arm on a radiolucent table 1
• Making a volar Henry approach or dorsal Thompson approach to the radius, depending on fracture characteristics, and carefully dissecting through soft tissues to protect neurovascular structures, particularly the superficial branch of the radial nerve
• Exposing the fracture, removing any hematoma and debris, then anatomically reducing the fracture under direct visualization and fluoroscopic guidance, and temporarily securing the reduction with K-wires if needed
• Selecting an appropriate plate (typically a 3.5mm dynamic compression plate or precontoured locking plate) and positioning it on the tension side of the radius, securing the plate with screws to ensure adequate fixation on both sides of the fracture
• Assessing the DRUJ stability through range of motion under fluoroscopy after radius fixation, and addressing any instability with temporary K-wire fixation or repair of the triangular fibrocartilage complex
• Irrigating the wound thoroughly, achieving hemostasis, and closing in layers, then applying a well-padded splint with the forearm in supination to protect the DRUJ
• Postoperatively, transitioning to a removable splint at 2 weeks and beginning gentle range of motion exercises, with progressive strengthening at 6-8 weeks as healing progresses, as recommended by the American Academy of Orthopaedic Surgeons 1. Key considerations in the operative management of Galeazzi fractures include:
• Restoring radial length and alignment to ensure DRUJ stability and forearm function
• Protecting neurovascular structures, particularly the superficial branch of the radial nerve
• Achieving stable fixation of the radius to allow for early range of motion and rehabilitation
• Addressing any instability of the DRUJ through temporary K-wire fixation or repair of the triangular fibrocartilage complex.

From the Research

Operative Procedure Steps for Managing a Galeazzi Fracture

The operative procedure steps for managing a Galeazzi fracture of the radius using open reduction and internal fixation with plating involve several key considerations:

• Assessment of the fracture and distal radioulnar joint (DRUJ) instability 2, 3
• Open reduction of the DRUJ with Kirschner wire fixation in pronation to reduce the joint and maintain anatomic alignment 4
• Repair of the triangular fibrocartilage complex to maintain stability of the DRUJ 4
• Plating of the radial shaft, which can be done on the lateral surface, providing an even and uniformly curved area for placing a plate 5
• Fixation of the ulna in a routine manner 5

Key Considerations

• The gold standard of treatment for adults with Galeazzi fracture-dislocation is open reduction and internal fixation with or without repair or pinning of the DRUJ 3
• Immobilization with the forearm in full supination in an above elbow cast can help maintain stability of the inferior radioulnar joint 6
• The distal end of the ulna should only be excised after 6 months, and if symptoms warrant it 6
• Plating the radial shaft on the lateral surface is a viable alternative to volar or dorsal plating of the radius, with comparable outcomes to existing literature 5