Galeazzi Fracture Dislocation |
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GALEAZZI FRACTURE DISLOCATION
Described by Riccardo Galeazzi of Milan. It is 3 times more common than Monteggia fracture dislocation.
It is the fracture of the radial shaft commonly at the junction of its middle and lower 1/3' along with rupture of ligaments of the inferior radioulnar joints and the displacement of the head of ulna from ulnar notch of radius. The fracture usually is transverse / short oblique.
Mechanism of Injury
Direct blow - dorsolateral aspect of lower forearm/wrist Indirect injury - fall on outstretched arm with marked pronation. Displacements
Gravity results in dorsal angulation of radius. Pronator quadratus pull on distal fragment tilts it medially and rotates it toward the ulna and pulls it proximally and palmar wards. Brachioradialis pivots and rotates the distal radial fragment with/without shortening. Ulnar head is shifted medially, posteriorly. With posterior dislocation of radioulnar joint. All these factor may cause early loss of reduction.
Clinical features
Slight pain with tenderness and swelling Moderate to severe displacement Obvious swelling, deformity and crepitus with radial shortening, posterolateral angulation and prominent ulnar head posteriorly due to ulnar dislocation are determined by palpation Most are closed fractures Neurovascular damage is rare.
X-ray
Fracture — transverse or short oblique at junction of middle and distal 1/3" with or without evidence of subluxation or dislocation.
AP view
Radius relatively shortened Increased space between distal radius and ulnar at site of articulation
Lateral view
Dorsal angulation of distal fragment Prominent ulnar head dorsally Associated avulsion of styloid process
Treatment
Aim
Perfect reduction and complete immobilization for restoration of full function Houghton's criteria of satisfactory reduction: Perfect alignment - anteroposterior and lateral No loss of length No subluxation of distal radioulnar joint in full pronation or supination
Closed reduction
Results with closed reduction are poor due to redisplacement and hence open reduction and internal fixation preferred especially in adults since it provides good anatomical position for union avoiding derangment and arthritis. Closed reduction by manual traction with supination may be useful in some cases in children.
Open reduction and internal fixation
An adequately long ASIF compression plate with uni-spaced compression screws is the best treatment If comminution present, manually replace each fragment It comminuted/oblique fracture, perform bone grafting in addition to plating It rotational instability exists, do a K wire percutaneous radio ulnar fixation Avoid intramedullary nail since the canal at this point is large and rotation and shortening cannot be prevented due to inadequate fixation
Immobilization
Full arm length plaster / sugar tong splint with elbow flexed at 90° and forearm supinated Keep for 6-8 weeks until fracture heals Active exercises after 2-3 weeks |