Chinese Journal of Traumatology 2013;16(6):344-346. 344 .

Chin J Traumatol 2013;16(6):344-346

A Galeazzi-variant type fracture-dislocation in adults

Raju Vaishya*, Sundar Kumar Shrestha, Abhishek Vaish

DOI: 10.3760/cma.j.issn.1008-1275.2013.06.005Department of Orthopaedics, Indraprastha Apollo

Hospitals, New Delhi, India (Vaishya R, Shrestha SK)Department of Orthopaedics & Rehabilitation, Sancheti

Hospital, Pune, India (Vaish A)*Corresponding author: Tel: 91-9810123331, Email:

raju.vaishya@gmail.com

AbstractObjective: Fracture of either radius orulna with a dislocation either at the proximal or distal radio-ulnar joint (DRUJ) is not a common injury and is inherentlyunstable. Here we report a case series, with both-bone fore-arm fractures associated with dislocation of DRUJ, as aGaleazzi-variant type fracture-dislocation, and try to ana-lyze this injury pattern.

Methods: The study was based on 6 patients havingGaleazzi-variant type fracture-dislocation of different age(20 to 45 years). All fractures were closed type. Two frac-tures involved the same level and three fractures were atdifferent levels of radius and ulna shaft. After thoroughexamination and investigations they were treated with limi-ted contact dynamic compression plate without additionalfixation for DRUJ.

Results: All cases were followed up for 24 weeks. Themaximum incidence occurred in age group between 31 and40 years. All the fractures of both radius and ulna wereunited in average time of 12 weeks. Range of motion of wristand elbow, supination and pronation at final follow-up werenormal. There was no subsequent re-subluxation or dislo-cation of the DRUJ in any of the cases.

Conclusion: Galeazzi variant in adult is a newundescribed pattern of forearm with wrist injury. Stable openreduction and internal fixation of both-bone forearm frac-tures is mandatory, followed by 3 to 4 weeks of immobiliza-tion in a cast for the healing of disrupted DRUJ.

Key words: Dislocations; Radius fractures;Ulna fractures; Wrist injuries

Galeazzi fracture-dislocation is a fracture of themiddle or distal shaft of radius and disloca-tion of the distal aspect of the ulna at the dis-tal radioulnar joint (DRUJ). This pattern of injury wasfirst described by Cooper1 in 1824. Galeazzi was giventhe credit for the fracture dislocation that bears his namebecause he reported a series of 18 cases of this injuryand his management. The Galeazzi fracture has beendescribed as a fracture requiring operative treatmentand accounts for 6.8% of all forearm fractures in adult.2

Here we propose a new entity of Galeazzi-variant typefracture-dislocation, as shaft of either forearm bone werefractured and DRUJ was dislocated.

METHODS

This study is a case series of 6 patients who pre-sented with closed fractures of forearm associated withdislocation of DRUJ from 2009 to 2012, confirmed by

anteroposterior (AP) and lateral X-rays of the forearmwith wrist (Figure 1). All these cases were treated onnext day of injury.

The radial and ulnar fractures were treated with openreduction and internal fixation by means of a 3.5 mmlimited contact dynamic compression plate (LCDCP).After fixation of forearm fractures, we noticed that in allcases, the DRUJ also reduced spontaneously (Figure 2).This was confirmed by both intraoperative image inten-sifier and postoperative X-rays. We also found that theDRUJ was stable in all cases and no additional fixationwas required. All these patients were given above el-bow back slabs for 3 weeks, followed by physiotherapy,after confirming the alignment of the fractures and DRUJ.Radiographs were taken at 6 weeks, 12 weeks andthen 3 monthly interval until 12 months. All cases wereevaluated clinically and radiologically for at least 6months.

RESULTS

The patients in our series were 22 to 45 years withmean age of (31.949.06) years. The maximum inci-dence occurred between 31 and 40 years. The majorcause of fracture-dislocation was motorbike accident

Chinese Journal of Traumatology 2013;16(6):344-346 . 345 .

and the common pattern of fractures was short oblique.All the fractures of both radius and ulna were united inaverage time of 12 weeks (Table 1). There was no sub-sequent re-subluxation or dislocation of the DRUJ inany of the cases (Figure 3).

The grip strength of both hands were measured andcompared in al l the patients with the help ofsphygmomanometer. It was more than 60% of oppo-

site side in all patients. Only one patient complained ofsome pain at DRUJ at 12 weeks follow-up visit.

In most cases, more than 45 degrees of dorsiflexion,palmar flexion, supination and pronation were possibleat the end of 12 weeks, except in one case that hadless than 45 degrees of dorsiflexion and supination andalso had associated humerus shaft fractures, which wasrare combination.

Figure 1. Preoperative AP (A) and lateral (B) X-rays showing both-bone forearm fractures with dislocation of DRUJ. Figure 2.Postoperative AP (A) and lateral (B) X-rays showing stable fixation of fractures with LCDCP and reduction of dislocated DRUJ. Figure 3.Twelve weeks follow-up X-rays showing stable reduction of DRUJ.

Table 1. Patients demographics and injury conditionVariables Cases (n)

Age group (years)

20-30

31-40

41-50

Mode of injury

Collision of vehicles

Motorbike

Fall from height

Pattern of fractures

Transverse

Short oblique

Comminuted

Union (weeks)

10

14

16

2

3

1

2

3

1

1

4

1

3

2

1

DISCUSSION

Galeazzi fracture-dislocation is characterized by itsunstable nature. A high index of suspicion should bemaintained by the treating surgeon and a thoroughexamination for instability of the DRUJ must be conducted.3

However, the injury complex described here (Galeazzi-variant type fracture-dislocation) is even rarer andseems more unstable.

Although Galeazzi fracture-dislocation historicallyhas been considered a combination of distal radius frac-ture and DRUJ dislocation, other associated injurieshave been described in the literature. Soon et al4 de-scribed a case of persistent radial head subluxationassociated with an ipsilateral radial shaft fracture. Thesubluxation, missed after the initial injury, was not di-agnosed until seven weeks later. Malik et al5 describedtwo cases of acute elbow dislocation with radial neckfracture and traumatic DRUJ dislocation, whereas Shiboiet al6 reported an unusual case of a posterolateral el-

Chinese Journal of Traumatology 2013;16(6):344-346. 346 .

bow dislocation with an ipsilateral Galeazzi fracture.

When treating Galeazzi fracture, it is important toobtain an anatomical reduction of the DRUJ at the timeof fixation of the radius, because persistent subluxationand instability at this joint are the most frequent sourcesof poor results. In the present case, after the radiusand ulna were adequately fixed with LCDCP, the DRUJthen became stable spontaneously and did not requireany additional fixation. Only temporary immobilizationin back slab seemed to be adequate for the healing ofDRUJ, as we did not encounter any residual or recur-rent subluxation of DRUJ in our series.

Two principal mechanisms of injury in Galeazzi frac-ture have been reported.7 Hughston8 has proposed thatGaleazzi fracture is usually caused by a direct blow tothe dorsoradial aspect of the forearm. On the other hand,Mikic9 has proposed that the most probable mecha-nism is a fall on the outstretched hand combined withextreme pronation of the forearm. He has related thatthe forces cross the radiocarpal joint, producing thedislocation and foreshortening of the radial shaft. He hasalso noted that as the displacement continues, dislo-cation of the ulnar head occurs with tearing of the trian-gular fibro cartilage, which then loses its stabilizing in-fluence on the wrist.

Our cases present as a Galeazzi-variant typefracture. From the pathological and therapeutic point ofview these injury differ from ordinary fractures of theforearm. Stable open reduction and internal fixation ofboth fractures of forearm bones is mandatory, followedby 3 to 4 weeks of immobilization in a cast for the heal-ing of disrupted DRUJ. The mode of injury is the sameas in the classic type of Galeazzi fracture-dislocation.The extreme axial loading from the impact of an out-stretched hand with a fully extended elbow and a pr-onated forearm, with the weight of the patients bodyacting as a driving force, could result in a Galeazzifracture. The fracture of ulna which obviously occursafter the dislocation of radioulnar joint, as force contin-ues to be applied, is the unique features of the injurythat might be considered differentiating characteristicsfrom typical Galeazzi fracture-dislocation. Because ofthe rupture of the triangular fibro cartilage, this Galeazzi-variant type fracture-dislocation is also extremelyunstable.9

A complete dislocation of the DRUJ always involvesrupture of the articular disc and of the associated dor-sal and volar distal radioulnar ligaments. This articularinjury, as well as the fracture of the radius and ulnamust be dealt with if good results are to be obtained.10

In conclusion, all forearm fractures should be givenan attention to the surrounding joints instability and mustbe operatively fixed for a favorable outcome and earlymobilization. However dislocation of DRUJ can be man-aged conservatively, if good reduction is achieved afterinternal fixation of the fractures.

REFERENCES

1. Cooper A. Simple fracture of the radius and dislocation ofthe ulna. A treatise on dislocation and on fractures of the joints.4th ed. London: Longman and Underwood, 1824:470-6.

2. Moore TM, Klein JP, Patzakis MJ, et al. Results of com-pression-plating of closed Galeazzi fractures. J Bone Joint SurgAm 1985;67(7):1015-21.

3. Van Schoonhoven J, Lanz U. Acute injuries of distal ulna. JHand Surg Am 1985;26:228-35.

4. Soon JC, Kumar VP, Satkunanartham K. Elbow dislocationwith ipsilateral radial shaft fracture. An unusual outcome. ClinOrthop Relat Res 1996;329:212-5.

5. Malik AK, Pettit P, Compson J. Distal radioulnar jointdislocation in association with elbow injuries. Injury 2005;36(2):324-9.

6. Shiboi R, Kobayashi M, Watanabe Y, et al. Elbow disloca-tion combined with ipsilateral Galeazzi fracture. J Orthop Sci2005;10(5):540-2.

7. Anderson LD. Fractures of the shafts of the radius and ulna.In: Rockwood CA, Green DP, eds. Rockwood and Greens Frac-tures in adults. 2nd ed. Philadelphia: Lippincott 1984:550-6.

8. Hughston JC. Fracture of the distal radial shaft. Mistakesin management. J Bone Joint Surg Am 1957;39(2):249-64.

9. Mikic ZD. Galeazzi fracture-dislocations. J Bone JointSurg Am 1975;57(8):1071-80.

10. Reckling FW, Cordell LD. Unstable fracture-dislocationsof the forearm. The Monteggia and Galeazzi lesions. Arch Surg1968;96(6):999-1007.

(Received January 8, 2013)Edited by Dong Min