Case Study: Closed Distal Radius Fracture Right (Galeazzi Fracture-Dislocation)

WESLEYAN UNIVERSITY – PHILIPPINES
College of Nursing and Allied Medical Sciences

Mabini Extension, Cabanatuan City-3100, Nueva Ecija
A.Y. 2022-2023
CASE STUDY:
CLOSED DISTAL RADIUS FRACTURE RIGHT
(GALEAZZI FRACTURE-DISLOCATION)
Submitted by:
Supan, Irish Mae B.
BSN 4-3
Submitted to:
Ma’am Virgiema Wycoco, RN
December 2, 2022
A.Y. 2022-2023
TABLE OF CONTENTS
I. Introduction
Profile of the Patient
Patient’s History
Definition
II. Anatomy and Physiology
III. Signs and Symptoms
IV. Risk Factors
V. Pathophysiology
VI. Diagnostic Procedures
VII. Medical Management
VIII. Surgical Management
IX. Nursing Management
X. Discharge Plan
A.Y. 2022-2023
I. INTRODUCTION
Profile of the patient
Name: Patient X
Age: 32
Sex: Male
Birthdate: January 8, 1990
Nationality: Filipino
Religion: Roman Catholic
Weight: 77 kg
Height: 183 cm
Ward: Surgical Ward
Attending Physician: Dr. X
Admitting Diagnosis: Closed Distal Radius Fracture (Right)
Procedure: Open Reduction Internal Fixation with plate and screw (Right)
Principal Diagnosis: Closed Distal Radius Fracture Right (Galeazzi Fracture – Dislocation)
Patient’s History
Allergies: None as claimed
Past Medical Hx: N/A
Family Hx: N/A

A.Y. 2022-2023
Definition
A distal radius fracture occurs when the radius — one of the two long bones in the
forearm — breaks close to the wrist. Distal radius fractures are very common. In fact, the radius
is the most commonly broken bone in the arm. A distal radius fracture usually always occurs 1
inch from the bone's end. This prevalent fracture can affect people of all ages in a variety of
ways. Such fractures frequently occur in young individuals as a result of high-energy incidents,
such as a fall from a ladder or an automobile accident. In older people, especially those with
osteoporosis, distal radius fractures can occur from a simple fall onto the wrist (Pidgeon, 2022).
Other ways the distal radius can break include:
o Intra-articular fracture — An intra-articular fracture is one that extends into the wrist
joint. ("Articular" means "joint.")
o Extra-articular fracture — A fracture that does not extend into the joint is called an extra-articular fractu
o Open fracture — When a fractured bone breaks the skin, it is called an open fracture.
These types of fractures require immediate medical attention because of the risk for
infection.
o Comminuted fracture — When a bone is broken into more than two pieces, it is called a comminuted frac
It is important to classify the type of fracture because intra-articular fractures, open fractures,
comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up
straight) are more difficult to treat than other types of fractures.

Forearm fractures can lead to significant short-term and long-
A.Y. 2022-2023
term disability if treated incorrectly. Sir Astley Cooper first described this particular fracture in
1822, but it was not until 1934 that the eponym took hold when Riccardo Galeazzi presented the
mechanism, incidence, and management of this injury.
The Galeazzi fracture is a fracture of the middle to distal one-third of the radius
associated with dislocation or subluxation of the distal radioulnar joint (DRUJ). 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.

A.Y. 2022-2023
II. ANATOMY AND PHYSIOLOGY
There are two long bones that make up the forearm:
The radius is on the thumb side of the forearm. The ulna is on the small finger (pinky) side.
At the proximal forearm, the part of the forearm closest to the elbow, the ulna is larger. At the
distal forearm, the part of the forearm closest to the wrist, the radius is larger. An interosseous
membrane, a slender sheet of fibrous tissue connecting the radius and ulna ensuring that they can
move in unison, lies between the two bones.
Humerus
Radius
Ulna
A.Y. 2022-2023
III. SIGNS AND SYMPTOMS
 Immediate pain with tenderness when touched
 Bruising and swelling around the wrist
 Deformity — the wrist being in an odd position
In very severe fractures, the nerve(s) to the hand can be affected by the injury, resulting in
numbness in the fingers.
IV. RISK FACTORS
a. Age
 Highest frequency in youths under the age of 18
 A secondary peak in older adults aged 50 and above
b. Health conditions
 Poor bone condition (osteoporosis, diabetes, rheumatoid arthritis, etc)
 Poor postural stability
c. Blunt trauma e.g. car accident
d. Strenuous Activities e.g. rock climbing,

A.Y. 2022-2023
V. PATHOPHYSIOLOGY
A.Y. 2022-2023
VI. DIAGNOSTIC PROCEDURES
Distal radius fracture can be diagnosed through the following:
 Patient’s health history
 Physical examination
 Imaging tests (X-ray, MRI, CT Scan)
VII. MEDICAL MANAGEMENT
Pharmacologic Treatment
 Painkillers – opioids
 OTC pain medications – ibuprofen, acetaminophen
Non-surgical Treatment
 Closed reduction
 Splint
 Cast
A.Y. 2022-2023
VIII. SURGICAL MANAGEMENT
OPEN REDUCTION AND INTERNAL FIXATION (ORIF)
A distal radius ORIF is a 30-90-minute outpatient surgery that is typically performed under
either general anesthesia or regional “nerve block” anesthesia. After the patient is comfortable
and asleep, the procedure is performed through the following steps:
a) An incision is made on the palm side of the forearm and wrist.

b) Surgical instruments are used to access the wrist and view the fracture.
c) The fracture is realigned and a combination of a plate and multiple screws are placed to
secure the fracture position.
d) The incision is closed using sutures and a plastic surgery technique to limit scarring.
Dressings are placed over the incision and a splint that extends from the mid-forearm to the palm
is placed over the dressings and secured with a light bandage. The elbow and fingers are left free
to allow motion.
A.Y. 2022-2023
IX. NURSING MANAGEMENT
a) Assess pain
 Elevate and support the affected area
 Apply an ice pack to reduce edema and hematoma formation and to decrease pain
sensation.
 Administer medication to reduce pain or muscle spasms, as indicated.
b) Cast and Wound Care

 To prevent infection, the cast and splint should be kept clean and dry.
c) Physical Rehabilitation
To help the patient regain complete movement of the affected area by collaborating with
a physical therapist.
X. DISCHARGE PLAN
If the patient is to be discharged, these are some instructions to be given for continuity of
care at home:
 Control swelling and pain.
Advise the patient to reduce swelling and pain by elevating and applying ice
packs to the affected area, and taking analgesics as prescribed.
 Care of the affected area.
Explain the management of immobilization devices or care of the incision.
Always keep it covered and wash hands often.
 Advise the patient to consume a diet to promote bone healing.
 Mobility aids.
Demonstrate the use of mobility aids and assistive devices safely.
 Advise the patient to avoid excessive use of injured extremity and observe weight-
bearing limits.

Case Study: Closed Distal Radius Fracture Right (Galeazzi Fracture-Dislocation)

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WESLEYAN UNIVERSITY – PHILIPPINES

College of Nursing and Allied Medical Sciences

CLOSED DISTAL RADIUS FRACTURE RIGHT

Profile of the Patient

II. Anatomy and Physiology

III. Signs and Symptoms

IV. Risk Factors

VI. Diagnostic Procedures

VII. Medical Management

VIII. Surgical Management

IX. Nursing Management

Profile of the patient

Birthdate: January 8, 1990

Religion: Roman Catholic

Ward: Surgical Ward

Attending Physician: Dr. X

Admitting Diagnosis: Closed Distal Radius Fracture (Right)

Allergies: None as claimed

Past Medical Hx: N/A

Family Hx: N/A

Other ways the distal radius can break include:

joint. ("Articular" means "joint.")

straight) are more difficult to treat than other types of fractures.

mechanism, incidence, and management of this injury.

estimated to account for 7% of all forearm fractures in adults.

II. ANATOMY AND PHYSIOLOGY

There are two long bones that make up the forearm:

move in unison, lies between the two bones.

III. SIGNS AND SYMPTOMS

 Immediate pain with tenderness when touched

 Bruising and swelling around the wrist

 Deformity — the wrist being in an odd position

numbness in the fingers.

IV. RISK FACTORS

 Highest frequency in youths under the age of 18

 A secondary peak in older adults aged 50 and above

 Poor bone condition (osteoporosis, diabetes, rheumatoid arthritis, etc)

 Poor postural stability

c. Blunt trauma e.g. car accident

d. Strenuous Activities e.g. rock climbing,

VI. DIAGNOSTIC PROCEDURES

Distal radius fracture can be diagnosed through the following:

 Patient’s health history

 Imaging tests (X-ray, MRI, CT Scan)

VII. MEDICAL MANAGEMENT

 OTC pain medications – ibuprofen, acetaminophen

OPEN REDUCTION AND INTERNAL FIXATION (ORIF)

a) An incision is made on the palm side of the forearm and wrist.

IX. NURSING MANAGEMENT

b) Cast and Wound Care

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