Contralateral wrist X-rays for comparison may aid in the diagnosis. The finding of the radius fracture and disruption of the DRUJ confirms the diagnosis of Galeazzi fracture dislocation. Radiographic assessment should include dedicated X-rays of the wrist, forearm and elbow. A comprehensive neurovascular examination is mandatory although neurovascular injuries in Galeazzi fractures are rare. Shortening of the radius may be evident depending on the extent and severity of the injury. Prominent ulnar head either dorsally or volary along with distal radioulnar tenderness is characteristic for DRUJ injury. Although painful, gentle passive and active wrist flexion and extension along with forearm rotation can be attempted. Tenderness to palpitation will be obvious in the site of the distal radius fracture and the distal radioulnar joint. In cases of a low energy isolated Galeazzi fracture clinical examination usually reveals gross deformity and/or swelling on inspection. In cases of an open fracture or high energy injury the Advanced Trauma Life Support protocol should be initiated to rule out any life-threatening injuries or hemorrhage. The worse results were noted in patients with type I fractures.Ī systemic approach should be utilized with any patient presenting with any orthopedic injury. also classified Galeazzi fractures into three types based on the location of the distal radius fracture type I was 0-10 cm from the tip of radial styloid, type II was 10-15 cm, and type III was >15 cm away from the radial styloid. A second classification system was proposed by Rettig and Raskin in 2001 which classifies the fracture based on the distance from the distal radioulnar joint, >7.5 cm or 7.5 cm from the articular surface and only one of them was shown to intraoperative instability of the DRUJ. Type 2 which is characterized by volar (posterior) displacement of the distal radius which makes it an apex dorsal (Figure (Figure6). in a report of 41 pediatric fractures which included: Type 1 which is characterized by a dorsal displacement of the distal radius (apex volar), and it is caused by axial load applied to the forearm while the forearm is in supination (Figure (Figure5) 5). There have been several classification systems to classify Galeazzi fracture dislocation, the first was described by Walsh et al. The dorsal and volar radioulnar ligaments of the TFCC also are paramount to maintain stability of the ulna and they are the main stabilizers of the DRUJ within the TFCC (Figure (Figure4) 4). Furthermore, the main stabilizer of the distal radioulnar joint is the triangular fibrocartilage complex (TFCC) which originates between the sigmoid notch and the lunate fossa on the radius, and inserts on the ulnar styloid and the fovea. The abductor pollicis longus and extensor pollicis brevis exert a shortening force upon the distal radius, the pronator quadratus muscle also exerts a rotational force, and finally the brachioradialis pulls the distal radius fragment proximally (Figures (Figures2, 2, ,3) 3). A number of deforming muscular forces are exerted on the distal radius. The IOM has the following functions that are of biomechanical importance: 1) Load transfer from the radius to the ulna, 2) Load transfer from wrist joint to the elbow, 3) Maintains a stable DRUJ, 4) Maintains forearm stability throughout range of motion. The IOM is a relatively weak attachment to the distal one third of the radius which may predispose it to subsequent shortening if an injury occurs through it. The radius and ulna are held together by the interosseous membrane (IOM) which is composed of the following: the proximal cords, accessory bands, distal band and finally the central band which is the strongest component of the IOM (Figure (Figure1).
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