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Galeazzi fracture-dislocations
ZD Mikic J Bone Joint Surg Am. 1975;57:1071-1080.

This information is current as of January 14, 2011 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org

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the Clinieal M. 967. I I. Fractures. C. N.t. J. female (26. into 43: Joint with 2: and the Y. Fracture dislocation first reported and Schnek Galeazzi’s teen cases on series. 0. ). : R.: HAR\EY. Forty-nine cent) were manual laborers.i4. the injury The The are results Accordingly. the Galeazzi fracture-dislocation is a of the shaft of the radius with an associated disloclassicfracture of the distal radio-ulnar articulation. NO.2i. Bone 968.21i. P.: with HICKS. M.Aureus Chronic OsteotiyeIttts.21. in the frac. J.: and WASHINGTON. of Open M.: Artificial Circulation: and Open Osteoniyelitis. V. S. The shaft is Galeazzi lesion. the classic of This kind of injury. 215-231. 453-456. IS. J.EARLY MANAGEMENT OF OPEN JOINT INJURIES 1071 Wound of Penicillin .4 also wrote about the lesion.4 side and patients (19. 7. B. Wong in 1967 and Cordell in in 1970 (twenty-six of the distal ulnar epiphysis: however. Surg. Management and COSENTRY. J.KOWSKE. J. Irrigation and Joint N.2 Clinical 57-A. G. ofOsteomyelitis by D#{233}bridement and Penetration Closed Irrigation-Suction. 8.: LARSON. R. Am. B. Reports C. P. and we had only one patient in the age this specific subject.22. and COCHRAN. Ninety-two of the patients male (73. DANIEL: M. New A Wounds Treatment Approach of to 1960.. This 1 fracture-dislocation rarely occurs in A survey of the literature revealed only a few articles children 14. P. DRFFt. Bone M. 56-A: RAii.: SCHAFFNER. Treatment The Antimicrohials Joint Fluid.: and 532-541. Literature. there resulted operative fragments radio-ulnar in failure treatment of joint the in 80 per were radius in this cent much and complex ofcases.. most of them reporting small group of birth to ten years.IASI: A. K. and twenty-five patients with a special cation type fracture of both bones and dislocation of the considered to be that part of the radius between the bicipiproximally and an area four to five centimeters distal radio-ulnar joint. and . April 1974. W. the largest series are those dren of is a fracture of the radius associated with separation in 1957 cases) cases) 21. Oct... Three Case C. and head. fourteen children eighty-six adults the - type fracture-dislocation of the forearm. Fractures Chronic II: Joints. J. twenty-four and and it (46. P. The equivalent lesion in chilTo my knowledge. I treated 125 in 1 822 by Sir Astley Cooper Judet injuries of the Galeazzi type. W. From 1964 type through Galeazzi lesion.. 2 1000 Novi Sad. but the eponym were fracture-dislocation is based on a series of eigh. 11: M. T. 8: Infections Orthopedics. VI. G.t7Ji. S. Front Fracture-Dislocations MIKIC. Drainage J.: and Forum. Dec.: J. Assn. 76-83. Intra-articular Got 63-65. Sad YUGOSLAVIA ABSTRACT: Among and 125 patients with the with Galeazzi- Clinical Material were By definition. better. 1945. is therefore excluded from this report. J. 48-A: 1534-1539. 0. Antibiotics.: The Bone 1960.. E. . Ku iv.. especially in the lesion with fractures radius and ulna. JR. FRANKEI.I5. Kii 1973. Broad Spectrum A. Orthop. are excluded from this series. t 213: l843-l)48. Yugoslavia.. VOL. Hughston (forty-four (twenty-three cases) 17 * (forty-one Reckling and Maurel cases) . and ofPenicillin Joint 49-A: Surg.SIAN. Irrigation marcescens. : ManagementofOpen and Joint The Permeability 1966. Surg.: J.D.1. 1965.:tu.:t2 and fifty (Fig. NOVI Non SAD. 1974. A. WILLIASIs: Bone and Joint and 27: Surg. T. and Other CIin. Trauma. J. DECEMBER . Clin. Staphylococcus . Treatment J. and Suction. JR. Ss1trIt-PETIRst:N. Cannulae.: SPEAR. Musculoskeletal The Role of Infections Antibiotics Due in the 13. D. 14. Orthop. of Surg.per cent). 1970. i)MAN.. J. However. J. 562-571.2 per of the fractures occurred on the right (53. Pxi/AKts.: JOHNSON.. Editorial. v.: J. DoslisRowski. 96: Med. 9. Galeazzi BY 2LELIMIR DJ.: Antibiotics. should of of the the shaft distal of the radius joint associated is a rare radio-ulnar with dered a a particular injury. be patients despite consiwith definition.*.: WIt. a Reappraisal J. KOENIG. In adults this methodfrom the distal articulating surface of the radius distally. GRIFFITH. Most were adults between the ages of twenty described in 1934 s. Fifty-eight per cent) sixty-seven (39. Hospital. HAMFION. II. the pathology 1968 prognosis of this injury in a child are quite different. and it appears that rigid internal tion is necessary for the dislocation as well as the ture. WiL.ER. M.. Conservative management tal tuberosity was successful only in children. R. Hajduk Veljkova 1975 1.: HiLi.: J. With combined fixation over half of the were excellent. and fractures of the the by radial radius a disneck dislocation stable. Hospital. 6. unwhich are occasionally associated with a disloof the distal radio-ulnar joint (Essex-Lopresti fracof cation the fixatures).: MARTIN.6 per cent) and thirty-three. W. 1415-1421 Resistant Oct. Ivt. Hsu. which are often accompanied of very location the of the ulnar head. Local of Traumatically Chemotherapy with Inflamed Primary Synovial Closure Membrane ofSeptic Wounds to Commonly by Means Used of C. 2.: and GROSSBERG. W. DuNN. : and HIuBi.6 per cent) on the left. with Closed to Serratia 475-475. F.present series cases in which the shafts of both the radius results and the ulna were fractured and the distal radio-ulnar joint was its dislocated deviation from are included. of fractures of the distal end of fracture (Colles’ fractures).

and disbut prox- The usual displacement to the ulnar side (60 volar. MIKIC number or cases 32 30 fracture.:4O movements Therefore. In the distal radio-ulnarjoint.2 (hyperpronation per or hypersupination).22. the quesin sixtythe triangular fibrocartilage is ruptured or consid-tion of whether one in determining the presence of a blow notto is the crucial lesion.:to. volar at the extreme of pronation and extension of curred the wrist middle or 56.22.1072 35 - . of dislocation shaft. it the forearm would seem to be essential for dislocation of in 3 1 . classified In eleven because cases of the type only of comminution.bo rbo rs it occurred to the dorsal. sides. farmers.. rupture or detachof the triangular fibrocartilage could occur and a discent) while at work on machines.4 per cent). The distal radio-ulnar joint is stabilized by various combined with extreme pronation of the forearm 17JI. and the the anterior pronator and quadis foreshortening continues. or 79.4 per cent) of the injuries fibrocartilage in this series.ii . (sixty-nine 20 fracture of the radius usually is composed cases in our series).was noted cases in the present series the ulnar head was fraccally and experimentally that a tear or detachment of four the tured and dislocated. and radial o-5_ 3-b . nineteen of loses this strong intra-articular ligament.28. nineteen (15. Pathology imally as well.-so _-- . dislocation occurs thirds in our shaft of most often at the junction of the radius (seventy-one series).. and the proximal of the forearm and importance of this particular lesion has not radius (two cases) are infrequent sites of the meaning the THE JOURNAL OF BONE AND JOINT SURGERY .2 1 . and less often cases. and medially (diastasis). In two patients a double curred. However.2t. cent) were injured the rest of our cases the mode Twenty-five of our patients in traffic accidents. and this was more evident din- ically than roentgenographically. Only rarely was the displacement in one direction. twenty-three cent).6 per cent) some of them the soft tissue was severely these fractures had marked displacement always was shortened. the avulsion of the ulnar styloid process forearms were injured. wives. It has been demonstrated clini. or 20.t.22. 15 The subperiosteal fracture with angular displacement 10 7 was noted in ten patients. of the :i. all less than Twenty-seven fractures (2 1 .2 per cent) housethe dislocation of the distal radio-ulnar joint was evident office clinically and roentgenographically.3() muscle). 5-A through 6-D).2 per and four. The fracture of the radius only two fragments (eighty-three forty-two cases (33. Although dislocation or 31. Age distribution in 125 cases 1 of Galeazzi fracture-dislocation. were open. were multifragmentary ocof but 25 22 20 - The transverse-type fracture was most frequent cases). ligament. But in those cases. In twenty-one cases the fracture was and could oblique fracture in fourteen.8 third cent).24.21. six.8 per cent) the ulnar mihead tially was only subluxated. All of and the radius per of the cent). and five in miscellane. forces the radial of the are producing radiocarpal thought to the dislocation As head cross and displacement with structures the posterior ratus the tear- (the ulnar radio-ulnar collateral ligaments. and if the early treatment was improper that produces the Galeazzi fracture-dislocation. workers.2 per cent (thirty-nine) of our patients. (18. but the most important stabilizing force triangular fibrocartilage There can be no dislocation of the distal radio-ulnar joint without rupture its 0.. sometimes (twenty-two cases. This which then occurred eight of our patients (54.:iii of the radius and if the of injury (20 joint per was exposed to an exaggerated rotational movement (15. FIG. beThere is some disagreement on the exact mechanism cause the triangular fibrocartilage was ruptured the joint was very unstable. In any case. of the Galeazzi-type lesion cases. Most of the time (ninety-nine cases.29 the distal third (five cases).24. dorsally. The most probable mechanism is a fall on the outstretched hand complete dislocation of the joint occurred later. (eight third of The cases). The specific function of the triangular is to limit ulna on one the rotational another ii. the wrist. not be spiral.2o a. Hughston ered the usual cause of this injury to be a direct the dorsoradial aspect of the forearm.:U The articulation.6 per cent) fractures.ment ous other ways: they were not able to explain how their location of the ulnar head was then possible. retired. per cent). rotational stresses on In this regard was equivalent to rupture of the triangular fibrocartilage. but that mechanism Galeazzi was responsible for only eight (6. and in the (thirty-nine the proximal was less The fracture and distal per the cent radial junction As mentioned. bones were fractured middle frequent. Dislocation of the ulna usually ocdiscus articularis is the first step to dislocation and occurs distally. cent). and in damaged.2 per of radio-ulnar joint with fractures of both bones middle thirds the distal was reported by some authors 13J6J9.4 per students. tal radial fragment was sixteen years old. in twenty-five was and cases (20 per cent) of the both was one in which the shafts the inferior radio-ulnarjoint dislocated (Figs. ulnar the occurs ing of the stabilizing triangular influence on fibrocartilage. Therefore. In was not determinable. DJ...

in cadavera of individuals over thirty of difficult. The positive arthroent series this happened only once. leOn was excluded. The clinical appearance is characteristic. but accordnerve was evident. tal radio-ulnar joint. of distal the Galeazzi it often seems fracture.27. minimum malalignment and shortening of radio-ulnar delayed joint. no recovery of the ulnar duces the clinical value of wrist arthrography. the triangular fibrocartilage fracture-dislocation quently the this sion. and (3) adults with fracture of both bones associated with dislocation of the distal an isolated fracture of the radius. of the of the is the a ulna which radio-ulnar occurs after force continues of be given the frac. In cadavera of persons following a Galeazzi fracture. young patients. no loss of length. The distal radioulnar joint the fracture delayed union as of always diagnostic of a disc rupture. but no obvious lesion wrist joints). usually an angular. Therefore. indicated injury the wrist the disc fracture-dislocation contrast medium a rupture of (Figs. the disloca-genographically to be ap. which seems shortened. and painful. five no patients rupture of arthrograms a Galeazzi filling of to those Galeazzi occurred.ulna . sidered of injury - is the bone the same as in Galeazzi lesion. helpful in is ruptured :t. However. The Galeazzi lesion is therapeutic are similar also of the special to use this had experience lesions. however. up to twenty years old no perforation was found. in a twenty-year-old patient with fractures of both bones which were initiallygraphic finding (the passage of contrast medium from the wrist into the inferior radio-ulnarjoint) cannot be regarded reduced and fixed with Kirschner wires. could not be established. Conse. the The cases).years be old the incidence of perforation was much higher. After eight months. This considerably reoccurred. the prognosis with classic sometimes i2.In cases of arthrogestablishing We unique feature differentiating of the injury characteristic Because this that might be conraphy from typical whether rupture Galeazzi of started have Galeazzi fracture-dislocations. Although dislocation misdiagnosed but the disruption :ti the should The diagnosis not fracture. the frequency of misdiagnosis. no subluxation of the distal ulnar joint also is deformed. (2) adults with the classic especially Galeazzi fracture-dislocation. NO. swollen. 8. The diagnosis jury is quite simple. and its occurrence prove thereafter. and poor. the roentgenographic appearance usually is normal the classic type at of first. it is advisable to some degree of restriction of motion of the elbow and carefully in every case of forearm fracwrist.We clinical and roentseries with reference to three groups of patients: ) chil-(1 radio-ulnar our joint dren is (up to sixteen years old). therefore. and mobile fracture than Every of usual. perforation of the triangular fibrocartilage of the nerve was found. is not always easy. When the ulnar head is only subluxated (in about 20 per cent of point of view these of forearm.t:t lesion and the differentiating distal fragment shortened but - of the radius the main and is the dislocation is present. The characteristic which always obviously joint. be joint with the basis In three of that finding. excessive scar. interosseous nerve also reported a case of an depends on the age of the subject. a positive arthrographic finding of noted. and no limitation of supination or pronation. The distal radio. concave deformity on the radial side of The results An result is one in which there is union.examination.Galeazzi normal. perfect the forearm. as radio-ulnarjoint. and in the third decade the perforation occurred only rarely (7. sociated examine ture.GALEAZZI FRACTURE-DISLOCATIONS 1073 been From lesions understood or the pathological differ from related and ordinary to the therapeutic fractures usual mode Galeazzi placed cally distal ture tion plied. providing a careful genographic examination of the distal Treatment and Results although high. to andbe in persons over sixty the perforation occurred in 53. because there often radio-ulnar joint a perforation is in the normal disc. of the course. is always radio-ulnar joint overlooked.6 per Diagnosis cent). subluxation of the ulnar head. will describe the treatment and results in ofthis complex in. 2-A through 2-D). are classified as excellent. in which the diagnosis the the wrist triangular joint can be fibrocartilage is uncertain. the joint can also be the radius. roentgenographic the radius must examination include the of inferior an tion. A fair is one in which there is one or more of the following: isolated result union.1 cent.excellent alignment. cases care must be taken with the physical and roentgenographically attention should to the problem of plus and minus variations of the These normal variations can be mistaken roentfor dislocations. and in these cases the diagnosis associated with an injury to the ulnar nerve In the presof Galeazzi fracture was confirmed. Then the distal end of the ulna was ing to my own reinvestigation of 100 fresh cadavera (I 80 sected and the nerve was explored. fair. no limitation of elbow and wrist funculnar head may seem to protrude and to be slightly more made whenever a fracture of the forearm. is encountered. An important criterion for a fair result is that subjecdiagnosis ofdislocation ofthe disof 1975 DECEMBER . There radio-ulnar is joint. and initial Our patients documentation were treated by many surgeons to in many cases was incomplete. VOL. but because dislocation with a fracture of the joint Roentgenographic 57-A. and both bones. In these is discriti. The radio-ulnar joint. Warren palsy st was and reduced closed but redislocation ofthe later distal and nerve function did not imdevelops from degenerative changes. per is often disc rupture may be considered reliable only in persons up thirty years old. showing method of diagnosis with it in eight In that three cases the the articular years ago and of suspected were disc had extremely problem and of the can unstable. aslimitation of pronation-supination up to 45 degrees.

MIKIC cellent result. of follow-up. 2-B revealed the of the contrast pinning of passage medium the radius of FIG. 2-B: the triangular Fig. Excellent results were obtained in only distal radio-ulnar joint. dislocation of without the success. and internal fixation of the radius The radius healed in an angulated position but funcpatients a closed reduction was Rush pinning of the radius. The tion was good and the result was rated fair. the papoor. but of the radius. 2-D: After seven months the anatomical and functional results excellent. but later. There were eight-six adult patients Galeazzi treated lesion. and when it failed a few days. an the radio-ulnar exjoint was transfixed FIG. In all cases early. 2-C: The arthrography fibrocartilage. while in a plaster cast. (80 per cent) classic the them and (39. The The slippage joint and usually occurred. some angulation and slipping of the fracture joint. Fifty-two adult patients (60. The follow-up period in our series was from six three months. Thirty-four of with closed reduction of these could incomplete. after the of tively the patient must be satisfied with the end is one or more ofthe following: reduction. non-union. The healing period of the conservatively treated fractures was usually two to elbow and wrist function. contrast and 2-C medium into transfixation the inferior FIG. tal portion of the ulna was performed. In ten done with percutaneous distal radio-ulnar joint in two cases in which. In most cases a In nine patients the results were excellent.5 per cent) immobilization evaluated remaining results that were only. 2-A with a dislocated distal radio-ulnar In most of these cases good position of the fracture fragments and good reduction of the ulnar head were obtained initially by means of manipulative reduction. nipulation. remarkable In two patients a second reduction was tried. 2-D the rupture of Fig. and fourteen records were tients. Closed reducwas always reduced closed except tion failed in only one patient: open reduction was then adequate. radio-ulnar Fig. done corded the closed operative reduction methods was at- the operation was done patients open reduction was performed. The end result in two patients was average with unknown time for because they were lost to follow-up. and in them the distal of more than 45 degrees. distal radio-ulnar joint. resection of the disIn fourteen patients with Kirschner wires without after internal six years fixation. DJ. In the group ofchildren there were fourteen patients. sixteen not be Of the had end because twenty were FIG. and therefore stable reduction was easily achieved by maprobably because most of the fractures were were quite varied. seven months. THE JOURNAL OF BONE AND JOINT SURGERY . The fracture healing was four to six weeks. deformity of the shortening or angulation eleven-year period. limitation of pronation-supination two patients treated conservatively. with an average of two years and forearm rotation occurred in five patients. and excessive restriction radio-ulnar of joint was only subluxated. indicating (ef) showed were the seriousness of the injury were to the performed. A twenty-four-year-old and suspected dislocation patient of of the radius radial fragments and subluxation or dislocation of the dis- the tal radio-ulnar supination-pronation result. loss of wrist occurred seven resulting and elbow to ten days in loss motion. In forty-two and only in a fifteen-year-old boy did redislocation of within the radial fragments (volar angulation) occur.5 per cent) were operated on They were treated by several surgeons over an of whom twelve were treated conservatively. forearm.I 074 z. tempted first. result is rated poor ifthere pain. Delayed union was noted in one patient and osteoarthritis of the distal radio-ulnar joint with painful months to eleven years. and pinning a fair In one result with sixteen-year- old boy percutaneous Rush was done was because reof fracture of the ulnar head. subperiosteal. The Closed reduction of the wrist joint extra-articular flow and percutaneous Rush radio-ulnarjoint.

with an excellent result in fair. After four weeks the wires were obtained. in a twenty-four-year-old man with an open fracture. Because of this. in the other the result was originally poor. 3-A FIG. as visualized intensifier. stabilize although Fig 3-B: Because the fracture was multifragmentary. One month postoperatively the plaster cast and Kirschner the fracture had not healed. Rush pinning of the radius was sucspiral fractures were fixed with wire loops and cessfully performed. with a poor re- transverse fractures the closed reducsuit in one patient and an unknown result in the other. and 3-C). In one patient with a poor through 4-E). five fair. Once transfixation results (six excellent. This technique was used fourteen in patients The most unsatisfactory results (none excellent. 3-C: Four months after operation the fracture was healed and the patient had a transfixation wires were full range of with removed motion. performed. the distal radio-ulnar because part of joint was of ulnar-head the ulna treated confracture. After rigid osteosynwhich the fractured ulnar head was also resected. In with satisfactory poor). the method of Rush pinning. (thirteen excellent. patients with the and generally a fair of the result radius was was achieved. of the Only of (onlay once. used in thirteen dislocation patients. 3-C Fig. The dislocation ofthe distal radio-ulnarjoint is Fig. one because 3-B. tory end result. onlay bone-grafting was performed Plating Primary bone-grafting screws) was used only As mentioned earlier. In fair and poor results. temporary in radio-ulnar transfixation. three NO. The heal- forty-three With results patients tion and were followed up. servatively. although the osteosynthesis malunion of the radius and redislocation when patient. result the was poor. in whom resection of the distal ulna was also performed. after four months. In most instances the healing period was two with the image to three months. a few of the distal years ago we began to stabilize the joint by percutaneous radio-ulnar joint occurred. onlay bone-grafting was done and a fair result was head of the ulna (Figs. 8. the failthesis ofthe radius the distal radio-ulnarjoint was reduced ure probably occurred because of technical error. onlay bone-grafting was performed with a satisfacpinning in most cases was two to three months. did we encounter non-union. and two radio-ulnar again results had been done result (Figs. and in the other it was unknown. 3-B. In the other poor result. 3-A: Multifragmentary fracture in the middle third ofthe radius in a thirty-one-year-old man. Radio-ulnar the distal radio-ulnarjoint. with simple percutaneous ing period for these fractures was four months. removed. poor) DECEMBER occurred 1975 in the patients treated with nine patients and a fair result in four. ulnar transfixation (five excellent and two fair results) (Figs. 3-A. four better 3-A. most patients with 4-A of complications with radial fracture. and3-C). ulnar-head sub- and 57-A. Of the patients operated on. We were especially pleased with the Two results of Rush pinning (open or percutaneous) and radiothe final result was excellent in one. Slight and one or two Kirschner wires were placed percutaneredislocation and non-union were evident after seven ously through the ulna into the radius slightly above the months. a six-hole plate was used. five with a classic Galeazzi fracture. Kirschner and physical wires was applied to therapy was initiated: (Figs. as the wire cut through the bone. VOL. Only once. in all bone with except graft a fair two fixed result. The healing period after Rush Later. seemed stable. 3-B FIG. was resection distal twice. were (Figs. it was stabilized sufficiently to begin rehabilitation. In ten We used K#{252}ntscher nails only twice. and one poor).GALEAZZI FRACTURE-DISLOCATIONS 1075 FIG. 2-A through 3-C). Kirschner intramedullary pinning of the radius. This patient four initially had a poor result. shown. fair. and in two we had satisfactory patients non-union was evident after six months. 2-A through 2-D). In one patient the . luxation or dislocation recurred.

two attained three (8 initially result and Fi#{236}. . who results were obtained with transfixation both bones centage of unsatisfactory of the treatment adults has been said: ‘We believe end results in similar. that the the treatment this fracture is due to most physicians’ lack ofknowledge of (Figs. our unfamilfor our lack of knowledge of its had infection (one closed and five open fractures). Discussion in reporting noted and that three treated the results had of forty-one been treated Of his fractures. 6-A through 6-D). thirty-four eight of them patients had were a good treated re- a slight the radius suit infection dewas plated. results 5-A through there was 5-D). Fig. thirty-five the result and only three treated per cent) had an unsatisfactory cent) were satisfactory. DJ. and operation A serious infection occurred in two patients treated tempt operatively (one closed and one open fracture). Hughston Galeazzi by closed thirty-eight (92 per by the . Four conservatively with unsatisfactory were operated on early in various tory results in 45 per in only three patients. In redislocation most cases of the joint (Figs.iarity teoarthritis of the joint was also noted. in four. radio-ulnarjoint with painful The radius remained of dis- a single reduction developed. and this with it. and Fig.the of forearm. The others ways. Of open reduction.fracture-dislocation in Hughston. MIKIC FIG. either of sequently. means patients thirty-eight by open reduction. Immobilization in plaster without any atweeks broke as the patient started physical therapy. Note discovered. In two patients painful os. and and three there poor). with fair and in the Complications results: other. The changes The made distal a year later. in to rigid Excellent whom radio-ulnar osteosynthesis cent). result patients veloped was unknown. was done in addition patients cent. later the fracture-dislocation in a forty-eight-year-old and closed reduction of the distal redislocation of the radius and the distal man. Osteoar. with unsatisfac. The result THE was rated poor. eight patients and plaster-cast good was Figs. OF BONE AND JOINT SURGERY JOURNAL .4-D FIG. therefore. were treated Our experience results. accounts tion of pronation-supination. 4-B FIG. the position nothing ofthe was radial done to fragments correct it. the 4-A: 4-B: distal 4-C: The classic Plating of radio-ulnar A month Galeazzi the radius joint. In the with fracture dislocation patients open reduction and internal fixation. patient had pseudarthrosis and restricted rotation per. Roentgenograms position. a successful result was achieved with ‘ initially in three of the We high or sub(30 per Galeazzi agree perof the distal ratho-ulnar joint. 4-A FIG. A successful result was thritis tients of the distal radio-ulnar (two poor and one fair third group there of both bones and joint result). Six patients ‘ of fair and poor forces the distal radio-ulnar mobilization rareness resulted in restric-The active when the customary reduction and irnis applied in the treatment of these fractures. of this fracture and. Delayed union complex ocaspects’ curred in six patients and non-union. 4-C good but Fig.was performed initially in six. were associated occurred twenty-four in three achieved pacent) treated in only three of Of the the thirty-four ten patients patients treated (9 by per conservatively.I076 z. 4-E a satisfactory series reduction was Open not third resulted in failure. radio-ulnarjointwere radio-ulnar carried joint was out. conservatively. at reduction was done in four patients. In Reckling and Cordell’s were treated initially by closed immobilization sult (five fair only. one in whom in were recorded formed in two (three in twelve poor patients and one :i and fair). In Wong’s series by manipulative reduction followed by immobilithe Kirschner wire which had not been removed after initially six zation in plaster. healed located rethe ulnar 4-D and 4-E: in a dislocated and osteoarthritic styloid process.

FIG. although the fractures of the fractures allowed this. of both the fracture and the dislocation and therefore the results of treatment Obviously . DECEMBER 1975 usuthe forearm in supination..the reduction must be adequate and ment. 5-D functional result after three years.GALEAZZI FRACTURE-DISLOCATIONS 1077 L 25 . tion should consist of an above-the-elbow The reduction ally is stable. 5-C was were removed and physical not healed. pinning of radio-ulnar the ulna Open reduction were performed. and the dislocation of the distal throughout the period of immobilization.1. because of the muscle forces which act in the distal radio-ulnarjoint are The Galeazzi syndrome in adults has been recognized and described as a very unstable fracture-disloca- . 5-A thirty-seven-year-old stretched left hand. transfixation and plating As the distal of the radius radio-ulnarjoint with a Kirschner wire was done. Initial ofboth bones. quite favorable children should VOL. the fracture lion of the distal radio-ulnar A woman fell from a roentgenograms show ofthe styloid process joint. NO. It can be reduced. radio-ulnar joint can also be reduced without difficulty. the situation is dif- An excellent anatomical and ferent. her outofthe shafts and dislocaAfter 1 FIG. this fracture-dislocation in be managed conservatively Of course. 5-B and was Rush unstable. bicycle onto the fracture ofthe ulna. 57-A. must be checked The immobilizaplaster cast with . When the lesion occurs in a child. The stable therapy fixation two months the Kirschner wire was begun. and the fracture then is usually subperiosteal with angular displace. FIG. This injury is quite rare in childhood. FIG. S.

joint dislocated. 6-D instability cartilage dislocations seems of the joint main and cause the of poor the re- The pins were removed and the distal end of the was resected. A 6-A were forty-tour-year-old fractured and man.30. MIKIC FIG. ulna the function of rated fair. DJ. of both hones was performed: the tion 8. was Both bones Roentgenograms tures healed in radio-ulnar joint made seven months satisfactory position. and the end result THE JOURNAL OF BONE AND JOINT SURGERY . occurred. The result after operation but redislocation was rated poor. 6-B Open pin in reduction the ulna and Rush is obviously too pinning short. the distal injured in radio-ulnar a traftic accident. are to be many rupture factors of responsible the triangular for frequent results the fibroThe which was FIG. the forearm improved subsequently.21. K.I078 1. show of the fracthe distal FiG. There However.

In many cases in the present series. Therefore. and anatomical fixation of a radial fracture at the same time must follow reduction of the radial fragments must the the be strong this maneuver arc so fibrocartilage that will obtain position. Bone and Joint 42-B: Surg. suggested the ulnar side ulna. third Because . ments immobilization. the possible and (Fig. ments better are fracture fracture to heal (Figs. In my opinthis is too aggressive. Radio-Ulnar Joint. absorption at the fracture site) there fractures in weight our always seems to be a tendency toward redislocation of the with severe softand difficult distal to radio-ulnar joint. and it may be better in such membrane. the pin for an radio-ulnar intramedullary enough. Conclusions should not be firmly drawn also will allow stable reducon the basis of a relatively small number of cases treated in ways. but it does seem that open reduction and of the distal radio-ulnar joint. with consequent K#{252}ntscher nail is strong and hence unsuitable radius.rigid method for treating the simple two-fragment fracture necessity. One must keep this in mind if this comprocedures that were perplex Its concavity faces tors. It is true that series tissue treat. involves the interosseous the of distal radio-ulnarjoint. 4-B and Because of many factors (strong muscle action. A. distal radio-ulnar with an asjoint. pronation-supination. M. Plating in cases of done will and stable most early cases. and prevents it stabilizes (Fig.: WOHL. - Kirschner wires are too weak ments against the deforming to stabilize forces which the radial fragwith unsatisfactory operate during temporary radio-ulnar References results - I believe also is that necessary. J.30. pin. As redislocation of the distal radio-ulnarjoint is very likely to occur it was present in all of my patients especially the double fracture of the radius. ALBERT. (and perhaps in all cases) to temporarily fix the and produces some re. VOL.. and there some of the fractures fractures) are still not always satisfactory. J. According to my different reinternal fixation of both bones is the first absolute Rush pinning (open or percutaneous) was a satisfac. 198-203. 3. H. been were complicated (open damage and comminuted but the The the main reason for inadequate surgical in many cases. radius is a curved not adequate. 3-B a six-hole plate because angulation Obviously Galeazzi in adults my opinion.21. M. 2. be reduced injuries addition. refixation bones the be is essenradio-ulnar fragments teosynthesis rigid internal of the distal firm oswithout 3-C). bone like the is most suitable and of if correctly the bone joint in makes the in joint.cases joint with one or two Kirschner wires. the results of the closed or dislocation recurred. the are ends of the and ruptured can heal in triangular optimum approximated both of bones the with for optimum such alignment. reduced period. 522-529. With Therefore. M. is the In Rush my opinion. Injuries ofthe 1975 Articular Disc atthe Wrist. but it was also encountered in several cases are obvibut they which in the osteosynthesis seemed solid (Figs. Bone and Joint Surg. DECEMBER . parallel to one any plaster and they another. which a purpose best device Fractures of is sufficiently sociated dislocation of the forearm. should also and must Moreover. is a flexible to follow and maintain same time strong enough to fragments. fracture a dislocation or with of and in a disturbance radius or the distal of the of one distal the radio-ulnar displaced results.32.: Der Treatment Chirurg.: and RECHTMAN. 4-B). it is for use of in the fraca of the of ulna or other a fracture of the fracture multifragmentary provide reduction the restoration of normal radiotures. reduction immobilization unsatisfactory The results ously better than The stability ofthe distal radio-ulnarjoint by conservative means. J.GALEAZZI FRACTURE-DISLOCATIONS 1079 Some leads to delayed displacement union and of the fragof ensue. cellent results. and the stability must Because internal distal and be of these fixation radio-ulnar of where Hughston facthe joint it bone. 57-A. problem. The medullary the distal third.: 1963. 1960. Although the must straight be proximalcurved radius bone and too rigid. In most cases. M.17. must be throughout the tal radio-ulnarjoint timum very and position. the are too few 4-C). 3-B) the In a is frag- establishment tial. A. canal of the radius is funnel-shaped and curved and narrow in the of this anatomical configuration. 8. of 40: the Disrupted 1969. Even rigid osteosynthesis of the radius does not guarantee stable reduction of the ulnar bad results seems to have head in all cases. This is understandable are uniformly which the reduction and fixation of the radial is a special subluxation in cases in fracture was in patients in those treated operatively treated conservatively. should always be middle the unstable is obviously in cases done. ion.. difficult it is quite the equal lengths of the if the fracture is displaced.: Gelenknahe COLEMAN. immediate resection of the distal portion of the fixation. tory and more difficult injury to manage than the classic the radial curve. and at much the secure good fixation of Galeazzi the lesion. to treat successfully understandable that and 5. additional fixation I. In rehabilitation unfavorable enough. anatomically healing an unstable and fixed maintained waiting for multifragmentary disin oppreferable. the radius in injury when have is to be treated open been reduction performed tested for something formed properly. Aug. S. BOHLER. NO. have The complex radius and mechanical ulna are nearly relationships results Accordingly.:to. exof the hand. ulna. but there are too few cases in his series to evaluate changes the value the ofthis procedure as initial treatment. because any deviation of the bone. 45-A: 1373-1381. Oct. ordinarily subluxation Any disproportion of the radio-ulnar and foreshortened associated with radio-ulnar From ulnar the joint joint standpoint function of in length joints t. Frakturen des Unterarmes. radius When must length affects striction is somewhat unsuitable for intramedullary a radial fracture is reduced the arc on be maintained. this tion suits. normal pronation-supination.

repeated to be Several theories of the pathogenesis and for treatment of recurrent elbow Recurrent dislocation of the elbow is so rare that few the surgical surgeons learn of the nature of the lesion and its surgicalhave been presented (Table I). orthop. 27. Radio-Ulnar S. 1. W. traumatthe Anatomy t. An Experimental Study otthe Radiocarpal Joint by Arthrography. Galeazzi Fracture-Dislocations in Singapore Incidence and Results ofTreatment. : and della of the articolazione Forearm.: C.: JAMESON. G. I 971. : M0INAR. A.. VOLZ. R. A. Surg. A. and ZHILA.: SCHNEPP. 1970. 44-A: 1664-1667. 1969.: 5. MAUREI PERIziINi. 24. BONE AND JOINT SURGERY . H. chir. Anterior N. ot the des Z.. Montedzha i Galeatstsi. LANG. G. Minerva Lesioni R. Int#{233}r#{233}t de l’arthrographie. povrezhdenii Handgelenken of the .Y. La fracture isol#{233}e Ia diaphyse de radiale Fractures isol#{233}es Ia diaphyse de avec ou sans luxation cubitus.Y. I. nd MANSAT. H1GHSTON. Reichenheim both concluded that ‘trochlear ‘ management by experience. MARTINEZ.. RECKLING. Ortop. Interosseous In Proceedings Nerve Palsy of the Western 1960-1964. humero-ulnar joint: Reichenheim Hood.the such the as less Review of the Literature suggestions dislocation King and notch Both sugof the nosis rent bone effective treatment. CH. 249-264. Chir.. D.. 36: These. Bone lechenila und Unfallheilk. M. A..: avambraccio. chir. THE JOURNAL OF transplanted the biceps King transplanted the and then Wainwright. 1969.: and CHABAL.: detei. UnfaIl-Chir. D. im Bereich der Atti Unterarmknochen. G. and PuRvis. Bone J.: and VASILEvSKIi. radiale. : Anterior Dislocation of the Ulna at the Inferior Radio-Ulnar Joint. ismes ROSE-INNES. Bone and anatomische Variationen der Handgelenkknochen. HLGHSTON. 10032.: Treatment Joint.iE: una particolare em besonderes Fracture Fractures sindrome traumatica Syndrom bei Verletzungen dello 50: 230-236.. 57 (Supplement 1): 253-260. 19. u Monteggia-Syndroms. Uber Mondheinser#{225}nderungen. and and BACCHEI.A. GALEAI1I.. 816-817. 57: 421-423. 1965.D. DE DE MOURGUE5.. investigation is to report on four recurrent dislocations of ‘ the * elbow Orthopaedic treated at the New Darnell New York Arms Orthopaedic Hospital.: Trait#{233}des fractures KESSLER. Elbow FREDERICK N. Kenntnis der Genese April 1957.1080 4. 30. PIETROGRANDE. 51: Forearm 1967. N... Bone and Joint Surg. 755-764.BERMAN. 17: 311-330.. J.. 33-40. D. f.. perelomov kostei verknei Der 942. R. C... Distal Radial Shaft. Deutsche Zeltschr. : Rotation R. DJ.. 1929.. .. . Oct. 25.. Orthop. J. J.. WARREN. 23. D.t. 1968.. 3 1. 32: 49-53. and PELTIER.1. and C0RDEI.. KovAiKoviTs. An intra-articular lesion was usually also present. . ortop. W. Aug. Lyon mem. in Adults. Recurrent BY MAJOR GARY C. der Pins. orthop. V. Surgery. Anatomical Considerations.: Ob osnovnykh travmat. C. SK0BIIN.: Di 7. 557-562. to the coronoid process.D. 1. 1971. traumatiche M. 12. G. RACKER. L. Texas 76544. Hospitalgested Fort a form of dynamic muscular stabilization Department. Considerazioni V. 9. E. blocks or and are thought relief to from offer an symptoms are techniques. 1955. G.: Fractures ofBoth Bones ofthe Forearm N. NEER II.. A.: The Galeazzi D. with a Discussion of of the Forearm. 1961. A. Surg. MANSAT. CH. 8: 186-193. Dec. .: CH. 29. zur sogenannten with Ortop. R. 9: 155-168. P. 1951. Zeitschr. 1913. Fractures. 1934. R. Em Beitrag Acta Radiol. protez. 13. 1 -512. 28. N. 1949. Aug. traumat. Rotation SCHNEK. 6. KNIGHT. FRITZ: Die Bedeutung der Subluxation im distalen Radioulnargelenk f#{252}r Behandlung die des Speichenbruches. Surg. J. GALEAZZI. 33-A: F. radius avec C. 2: 12. and THOMPSON.. S. 30: 9-16. Mistakes in Management. RAM’oicil. W. konechnosti 88-90. printisipakh des GaleazziHefte de and Joint31-A: Surg. Lyon chir. ABSTRACT: Recurrent dislocation of the elbow re-between 1955 and 1974: to review the pertinent literature: that the critical lesion is laxity of the latsuited from laxity of the lateral capsule and collateral to re-emphasize eral ligaments and capsule and that treatment should be diligament in four patients. OI. 1949. Bone and Joint Surg. 42: 17. Rev. Arch. 216: 351-356. UNITED M.: Lesions de I’articulation radio-cubitale inf#{233}rieure dans les de Ia’avant-bras et du poignet. MIKIC J. . 1928. and SI1.. I. : JOHNSON. L.. Elle Am. J. 993-996.: 10. For example. 18.: 75-91 Fracture. . and initial management prevention of finally. 8. Oct. Orthopaedic ofForearm Association. Ia radio-cubitale inf#{233}rieure (Fractures su due rare fratture di 1-85. MERHOF. BRUNN.: Das Fracture distale du Radio-ulnargelenk.. of STATES NEW the ARMY.: membres. J. Expansion Scientifique of the Bone Joint zur and Joint 39-A: Surg. J. 20. Aug. Toulouse.: as a Complication Joint45-B:Surg. : Unstable Fracture-Dislocations 96: Surg. : R#{246}entgenstudien M. Galeazzi).. 1960. RECKLING. RAY. 11-24. P. JUDET. . du scheletro dell’avambraccio. YORK. I 5. : Zur operativen Behandlung BONDARENKO. 14. 1971. of the An Forearm. and 112: Obstet. radio-ulnare Experimental The distale. Forearm. protez. J. of Pronation and Supination. The purpose of the present insufficiency’ was the primary mechanism. 1967. N. Aug. S. 1961.622 West York. I. travmat. R. Chirurg. Singapore Med. R.I’. 42-B: 515-521. HULTEN. Case Reports. Bone and and Joint 51-A: . 51 WONG. 16. while biceps through the coronoid. 107: STUCK. 168th Street. J.: Riccardo Galeazzi and Galeazzi’s Fracture. 32. Minusvariante Intramedullary (Hult#{233}n). KORZH. G. J. a M.: Lechenia zastarelykh an of Clin. Lomb. believed excellent of progquire recur. and 1969. HASSMANN*.I’. 2 I.. : and KRASINAI. 22. of to offer posterior dislocations. chir. 35: 1935. Arch. : Uber J.: The Distal G. zwei verschiedener Fran#{231}aise. 1965.. 58: 453-459.. AND MEDICAL CHARLES Dislocation CORPS. FRIr/: . P. Much. and Galeazzi Lesions.. F. z. Surg. Fractures Orthop.: RICARD. I I. Paris. of 999-1007. 1962. Ic. Seine luxation de bedeutung in der Unfallmedizin. dislocation. J. Gynec. June 1963. S. Study Monteggia 16: 544-547. RIENAL. 77: 12-18. STEINHAUSER. F.. J. Soc. Ortop. R. VESELY. 26. 1949. J. April f. recommendations elbow dislocation for for complicated transfers. GAY. Elbow arthrotomy for removal rected of to this lesion: to emphasize that internal derangeloose bodies and repair of the lateral capsuloligamenment and loose bodies may be present in the joint and retous structures for satisfactory More tendon unnecessary.

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