8/30/2020 Galeazzi Fracture: Practice Essentials, Pathophysiology, Etiology

This site is intended for healthcare professionals

Galeazzi Fracture
Updated: Apr 02, 2020
Author: Janos P Ertl, MD; Chief Editor: Harris Gellman, MD more...

OVERVIEW

Practice Essentials
The Galeazzi fracture-dislocation is an injury pattern involving isolated fractures of the junction of
the distal third and middle third of the radius with associated subluxation or dislocation of the distal
radioulnar joint (DRUJ); the injury disrupts the forearm axis joint. [1, 2] (See also Forearm Fractures
in Emergency Medicine and Distal Fractures of the Radius.)

The Galeazzi fracture injury pattern was first described by Cooper in 1842, 92 years before
Galeazzi reported his results. Ricardo Galeazzi (1866-1952), an Italian surgeon at the Instituto de
Rachitici in Milan, was known for his extensive work experience on congenital dislocation of the
hip. In 1934, he reported on his experience with 18 fractures with the above-described pattern as a
compliment to the Monteggia lesion. Such fractures have since become synonymous with his
name.

In 1941, Campbell termed the Galeazzi fracture the "fracture of necessity," because it necessitates
surgical treatment; in adults, nonsurgical treatment of the injury results in persistent or recurrent
dislocations of the distal ulna. Although researchers have been unable to reproduce the
mechanism of injury in a laboratory setting, Hughston outlined the definitive management of these
fractures in 1957. [3]

Pain and soft-tissue swelling are present at the distal-third radial fracture site and at the wrist
joint. Anterior interosseous nerve (AIN) palsy may also be present, but it is often overlooked
because there is no sensory component to this finding.

The diagnosis of a Galeazzi fracture is confirmed on radiographic examination. Radiographs of the

contralateral extremity can be obtained for comparison. Assessment of DRUJ integrity is often
difficult with plain radiography alone. Bilateral axial computed tomography (CT) of the forearm is
the preferred imaging study for diagnosing DRUJ disruption.

Galeazzi fractures are best treated with open reduction of the radius and the DRUJ; closed
reduction and cast application have led to unsatisfactory results. As a "fracture of necessity," the
adult Galeazzi fracture is not amenable to treatment by closed means, necessitating surgical
stabilization.

Pathophysiology
The deforming forces in a Galeazzi fracture include those of the brachioradialis, pronator
quadratus, and thumb extensors, as well as the weight of the hand. The deforming muscular and

https://emedicine.medscape.com/article/1239331-overview#showall 1/3
8/30/2020 Galeazzi Fracture: Practice Essentials, Pathophysiology, Etiology

soft-tissue injuries that are associated with this fracture cannot be controlled with plaster
immobilization.

Etiology
The etiology of the Galeazzi fracture is thought to be a fall that causes an axial load to be placed
on a hyperpronated forearm.

Epidemiology
Galeazzi fractures account for 3-7% of all forearm fractures. They are seen most often in males.
Although Galeazzi fracture patterns are reportedly uncommon, they are estimated to account for
7% of all forearm fractures in adults.

Prognosis
Successful treatment of Galeazzi fractures depends on the reduction of the radius and DRUJ and
the restoration of the forearm axis. Hughston outlined the difficulties and complications of
nonoperative treatment in 1957. [3] An unsatisfactory result—caused by a loss of reduction that, in
turn, led to malunion—was identified in 92% of patients (35 of 38) treated with closed reduction
and cast immobilization.

Hughston's study attributed loss of reduction to the deforming force of the brachioradialis, the pull
of the pronator quadratus (leading to rotation of the distal radial fragment towards the ulna), and
the weight of the hand as a deforming force (leading to dorsal angulation of the radius and
subluxation of the DRUJ). These deforming forces cannot be controlled with plaster immobilization;
operative management is required.

The incidence of nonunion of Galeazzi fractures is very low. The rate of union following the open
reduction of forearm fractures has been reported to approach 98%. [4]

Reckling and Moore separately reported satisfactory results with compression plating and
immobilization in supination. [5, 6]

Eberl et al retrospectively reported on Galeazzi lesions over a 3-year period in 26 patients. [7]
Casting after fracture reduction was possible in 22, of whom 13 were treated with immobilization in
a below-elbow cast and nine were treated with an above-elbow cast. Four patients were treated
operatively. Results were excellent in 23 cases and good in three. The authors noted that in all
cases of distal forearm fractures, a possible Galeazzi lesion should be considered but that proper
reduction of the radius with concomitant reduction of the DRUJ and cast immobilization provides
good-to-excellent outcome even if the Galeazzi lesion is not recognized primarily.

Ploegmakers et al retrospectively reviewed Galeazzi fractures to determine their effect on the

strength of pronation and supination at a mean of 2 years after surgery. [8] They found that the
mean absolute loss of strength of supination in the injured arm compared with the noninjured arm
throughout all ranges of forearm rotation was 16.1 kg, corresponding to a relative loss of 12.5%.
https://emedicine.medscape.com/article/1239331-overview#showall 2/3
8/30/2020 Galeazzi Fracture: Practice Essentials, Pathophysiology, Etiology

For the strength of pronation, the mean loss was 19.1 kg, corresponding to a relative loss of
27.2%.

Loss of strength of supination following a Galeazzi fracture correlated with poor quickDASH
(Disabilities of the Arm, Shoulder, and Hand) and PRWE (Patient-Rated Wrist Evaluation) scores.
[8] Loss of strength of pronation (27.2%), and of supination (12.5%) in particular, after a Galeazzi
fracture is associated with worse clinical scores, highlighting the importance of supination of the
forearm in function of the upper limb.

Ilyas et al, in a study of 10 patients with AO type A and C distal radius fractures who underwent
fracture fixation, found that intramedullary nailing for displaced distal radius fractures could result in
good functional outcome but had a high incidence of complications. [9] The authors did not identify
any long-term soft tissue problems but noted that intramedullary nails should be limited to extra-
articular and simple intra-articular distal radius fractures.

In this study, all cases maintained reduction between postoperative and final radiographs, except
for two cases of AO type A3 fractures with a loss of volar tilt greater than 5º. [9] Grip strength
relative to the uninjured limb was 91%. According to the DASH questionnaire, eight results were
excellent, one good, and one poor. There were two cases of transient superficial radial sensory
neuritis and three cases of screw penetration into the DRUJ. There were no cases of infection,
tendon injury, or hardware failure or removal.

Clinical Presentation

https://emedicine.medscape.com/article/1239331-overview#showall 3/3