Step-by-Step Treatment for Galeazzi Fracture with Plating
The definitive treatment for a Galeazzi fracture in adults is open reduction and internal fixation (ORIF) of the radial shaft fracture with plate fixation, followed by assessment and appropriate management of the distal radioulnar joint (DRUJ) instability. 1
Pre-operative Assessment
- Obtain standard 3-view radiographs of the wrist (posteroanterior, lateral, and 45° semipronated oblique) to confirm the diagnosis of Galeazzi fracture-dislocation 2
- Consider CT imaging if initial radiographs are equivocal or to better characterize the fracture pattern and DRUJ involvement for surgical planning 2
- Classify the fracture based on location:
Surgical Technique
Step 1: Patient Positioning and Preparation
- Position patient supine with the affected arm on a radiolucent hand table 4
- Prepare and drape the entire forearm from elbow to fingertips 4
- Apply tourniquet at upper arm level 4
Step 2: Surgical Approach
- Use a volar (Henry) approach or dorsal (Thompson) approach to the radius based on fracture pattern and surgeon preference 4
- Make a longitudinal incision along the radial shaft at the fracture site 4
- Carefully dissect through soft tissues to expose the fracture site while protecting neurovascular structures 4
Step 3: Fracture Reduction and Fixation
- Perform anatomic reduction of the radial shaft fracture 4, 5
- Apply a dynamic compression plate (DCP) or locking compression plate (LCP) to the radius 4
- Ensure rigid internal fixation with at least 6 cortices of fixation on each side of the fracture 4, 6
- Confirm adequate reduction and plate position with intraoperative fluoroscopy 4
Step 4: DRUJ Assessment and Management
- After radial fracture fixation, assess DRUJ stability through full forearm rotation 3
- If DRUJ is stable after radial fixation, no additional fixation is needed 4
- If DRUJ remains unstable, consider the following options:
- Immobilize the forearm in full supination with an above-elbow cast for 6 weeks 5
- For severe DRUJ instability, perform temporary DRUJ fixation with Kirschner wires 5, 6
- In cases with soft tissue interposition, open reduction of DRUJ may be necessary 4
- For triangular fibrocartilage complex (TFCC) injuries, direct repair may be required 3
Step 5: Wound Closure and Post-operative Care
- Irrigate the wound thoroughly 2
- Close the wound in layers 2
- Apply sterile dressing and splint 2
- Administer appropriate antibiotic prophylaxis for closed fractures 2
Post-operative Management
- If DRUJ is stable: Short arm cast for wound healing period, then transition to functional rehabilitation 4
- If DRUJ was unstable and fixed with K-wires: Above-elbow cast in supination for 6 weeks 4, 5
- Remove K-wires at 6 weeks if used 4
- Begin progressive range of motion exercises after cast removal 4
- Monitor for complications including malunion, limited forearm rotation, chronic pain, DRUJ instability, and osteoarthritis 1
Special Considerations
- In children, closed reduction and casting is often sufficient 1
- Elderly patients may require special attention to bone quality and fixation methods 2
- Open fractures require thorough debridement and appropriate antibiotic coverage 2
- For fractures with bone loss or comminution, consider bone grafting 2
Common Pitfalls to Avoid
- Missing DRUJ instability after radial fixation - always assess DRUJ stability intraoperatively 3, 1
- Inadequate fixation of the radius leading to malunion or nonunion 4
- Improper positioning during immobilization - supination position is critical for DRUJ reduction 5
- Prolonged immobilization leading to stiffness - balance between stability and early motion 4
- Failure to recognize and address associated soft tissue injuries 3