What is the treatment for a Galeazzi fracture?

Treatment of Galeazzi Fracture

The standard treatment for Galeazzi fracture is open reduction and internal fixation (ORIF) of the radial shaft fracture with plate fixation, followed by assessment and management of distal radioulnar joint (DRUJ) instability.

Understanding Galeazzi Fracture

A Galeazzi fracture is characterized by:

• Fracture of the distal third of the radial shaft
• Associated dislocation of the distal radioulnar joint (DRUJ)
• Typically occurs from axial loading on an outstretched arm with pronation or supination

Classification

Based on fracture location 1:

• Type I: Fracture in the distal third of radius (within 7.5 cm of midarticular surface)
  • Higher risk of DRUJ instability (55% of cases)
• Type II: Fracture in the middle third of radius (more than 7.5 cm from midarticular surface)
  • Lower risk of DRUJ instability (5.5% of cases)

Treatment Algorithm

1. Initial Management

• Radiographic assessment to confirm diagnosis and classify fracture
• Temporary splinting for pain control and prevention of further displacement

2. Definitive Treatment

• In adults: Surgical management is strongly indicated 2

  • Conservative treatment in adults has an 80% failure rate

• In children: Conservative management can be successful 2

3. Surgical Approach

• Primary procedure: Open reduction and internal fixation of radial shaft fracture
  • Typically via anterior (volar) approach to the forearm 3
  • Plate fixation is the standard method for stabilizing the radius

4. DRUJ Management

• After radial fixation, assess DRUJ stability intraoperatively
• If DRUJ remains unstable after radial fixation, additional interventions are needed:
  • Wire transfixion of the DRUJ 1
  • Open reduction and triangular fibrocartilage complex repair 1, 4
  • Kirschner wire fixation in pronation may be necessary in cases of volar DRUJ dislocation 4

5. Alternative Techniques

• Percutaneous elastic stacked nailing has shown promising results in select cases 5:
  • Two elastic titanium nails of unequal lengths and diameters
  • One acts as reduction nail, the other as stabilizing nail
  • Advantages include technical simplicity and minimal cost
  • Reported excellent results in 18 of 22 patients in one study

Postoperative Care

• Immobilization in a cast or splint for 2-4 weeks
• Progressive rehabilitation with range of motion exercises
• Radiographic follow-up at 6 weeks, 3 months, 6 months, and 1 year 6
• Monitor for complications including:
  • Hardware-related pain
  • Infection
  • Malunion
  • Chronic DRUJ instability

Common Pitfalls and Considerations

• Failure to recognize and address DRUJ instability leads to chronic problems 1
• Rigid internal fixation is necessary for both the fracture and DRUJ dislocation 2
• Failed or inadequate treatment may lead to:
  • Chronic pain
  • Malunion
  • DRUJ instability requiring salvage procedures 3
• Hardware removal may be necessary in some patients due to discomfort at insertion site 5

Key Points for Optimal Outcomes

• Early recognition and treatment
• Anatomic reduction of the radial shaft fracture
• Assessment and appropriate management of DRUJ instability
• Adequate postoperative rehabilitation