Galeazzi Fracture: Causes, Symptoms, Treatment, Prognosis

A Galeazzi Fracture occurs as a result of a series of fractures or broken bones at the meeting point of the distal third and middle third of the radius along with dislocation of the DRUJ or the distal radioulnar joint. The most common cause of a Galeazzi Fracture is believed to be a fall from a height such that the arm gets hyper-pronated putting excessive load on it. Studies estimate that about 7% of all forearm fractures diagnosed are Galeazzi Fractures.^[1]

Surgery is the primary mode of treatment for Galeazzi Fracture. If there is a delay in diagnosis and surgery or if a conservative approach is followed for treating this fracture then it may result in frequent dislocations of the arm at the distal ulna. Radiographs can clearly show a Galeazzi Fracture with multiple fractures along the DRUJ being clearly seen on plain films. The overall prognosis of an individual with a Galeazzi Fracture is quite good with surgical treatment.^[1]

As stated, the primary cause for a Galeazzi Fracture is believed to be a fall from a height. A slip and fall may also cause a Galeazzi Fracture in some cases but this is not so common. A fall that causes over-pronation of the arm with the whole body weight falling on it often results in a Galeazzi Fracture.^[1]

This is something that usually does not happen with a fall and this is the reason why only 7% of all forearm fractures are Galeazzi Fractures. There is gender prevalence to this fracture with males tending to get it more than females. They can occur both in children and adults.^[1]

As is the case with all fractures, a Galeazzi Fracture will cause severe pain, swelling, and inflammation at the site of the injury. There will also be restriction of range of motion around the elbow. The swelling may also be present at the wrist joint as well. In some cases, the patient may also experience symptoms of compartment syndrome. This will include numbness and tingling in the affected extremity. The affected limb will also feel weak.^[1]

Some patients experience anterior interosseus nerve palsy as a result of Galeazzi Fracture. As a result of this palsy, the individual will find it tough to appose index finger and thumb of the affected arm.^[1]

Radiographs are the primary way of diagnosing a Galeazzi Fracture. For best views, the lateral and AP views of the elbow are obtained on x-rays. Additionally, PA lateral view of the wrist is also obtained for accurate diagnosis. For comparison purposes, a radiograph of the unaffected arm can also be obtained. The films will clearly show the characteristic features of a Galeazzi Fracture in which there will be an oblique or transverse fracture of the radius along with dislocation of the distal ulna. There will also be ulnar positive variance observed on radiographs.^[1]

Additionally, an injury to the distal radioulnar joint can be observed with fracture of the base of the ulnar styloid clearly observed. The AP view will show widening of the DRUJ space. The radius will also be shorter than the ulna on radiographs. All of these findings will positively confirm the diagnosis of Galeazzi Fracture. Additionally, for further confirming the diagnosis a CT or an MRI scan may also be obtained.^[1]

Surgery is the primary and the most preferred way of treating Galeazzi Fracture. This is because studies have shown that conservative treatment with a splint or a cast has led to frequent dislocations of the radius. The surgery of choice is an open reduction internal fixation of the radius and DRUJ. If the fracture is open then it requires immediate surgery to prevent contaminants from infiltrating the body and infection to set in.^[1]

However, closed reduction and casting is preferred for children as their bones are still in the developing stage. Surgery is also contraindicated in individuals who have underlying medical conditions that prevent them from having any surgical procedures. Immune compromised patients also are deemed not to be a candidate for surgery. In such cases, surgery is not done until the patient is fit enough and cleared by respective specialties to undergo surgery.^[1]

Research is ongoing with regard to the use of intramedullary nailing as a treatment option for Galeazzi Fracture. The research is still in the preliminary phase and more work needs to be done with regard to the safety and efficacy of using this method of treatment for Galeazzi Fracture. Postsurgery, radiographs will be obtained again to check whether the fracture is stabilized correctly and there is no indication of a deformity being present.^[1]

The patient will then be placed in a splint for about 4-6 weeks till the wound completely heals and the fracture is completely stabilized. The patient will then require aggressive physical therapy as is the norm with most surgical procedures done for fractures due to the stiffness that evolves due to immobilization.^[1]

The overall prognosis for a Galeazzi Fracture after surgical treatment is quite good. It is extremely rare for a Galeazzi Fracture to end up with a nonunion after surgical fixation. However, if the patient is treated conservatively then the prognosis is more guarded with the chances of a nonunion of the fracture being reported to be more.^[1]

In fact a study suggests that of all cases of Galeazzi Fracture that were treated non-operatively 92% ended up with not so good results with incomplete restoration of arm function and other functional abnormalities. Nonoperative treatments also resulted in the arm being weak with poor grip strength and lifting abilities with the affected hand which is not the case of the Galeazzi Fracture is treated surgically. Thus it is recommended that if a Galeazzi Fracture is diagnosed then to proceed with surgery to have the best chance of regaining the lost function of the hand due to this severe injury.^[1]

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