bubble_chart Overview

In 1929, the French referred to it as an anti-Monteggia fracture. In 1934, Galeazzi provided a detailed description of this injury, which has since been called a Galeazzi fracture. The incidence of this injury is six times higher than that of a Monteggia fracture.

bubble_chart Pathogenesis

Direct external forces, such as blunt trauma or machine entrapment, can cause this type of fracture. Indirect forces, like falling and landing on an outstretched hand, can also lead to such fractures. They can be classified into the following three types.

1. Distal radius greenstick fracture combined with ulnar head epiphyseal separation: Both occur in children. This type of injury is mild and easy to reduce.
2. Fracture of the distal third of the radius: Mostly transverse or short oblique. There is significant shortening and dislocation of the distal radioulnar joint. It is often caused by falling on an outstretched hand. When the injury occurs with the forearm in pronation, the distal radius displaces dorsally; if the injury occurs in supination, it displaces volarly. The latter is more common clinically. This type of injury is more severe. It involves injury to the distal radioulnar ligament, triangular fibrocartilage complex, interosseous membrane, and fracture of the ulnar styloid.
3. Fracture of the distal third of the radius with dislocation of the distal radioulnar joint and concomitant fracture of the shaft of the ulna or traumatic bowing of the radius and ulna: Mostly caused by machine entrapment. The injury is severe and may be open. In addition to injury to the distal radioulnar ligament and triangular fibrocartilage complex, the interosseous membrane injury is also more severe.

bubble_chart Clinical Manifestations

In cases with minimal displacement, symptoms include only pain, swelling, and tenderness, along with limited forearm rotation. In cases with obvious displacement, the radius exhibits shortening and angular deformity, tenderness at the distal radioulnar joint, and prominence of the ulnar head.

X-ray imaging reveals a transverse or short oblique fracture at the junction of the lower third of the radius, usually without severe comminution. If the fracture of the radius is significantly displaced, the distal radioulnar joint will be completely dislocated. On anteroposterior X-ray films, the radius appears shortened, the distance between the distal radius and ulna is reduced, and the radius moves closer to the ulna. On lateral films, the radial head shows volar angulation, and the ulnar head protrudes dorsally.

bubble_chart Treatment Measures

Closed reduction is relatively easy. However, maintaining the reduced position is more difficult due to muscle contraction. The pronator quadratus, brachioradialis, extensor pollicis longus, and abductor pollicis longus muscles cause overlapping displacement of the distal fracture fragment and convergence toward the ulnar side, resulting in a low success rate of closed reduction. The treatment outcomes are unsatisfactory. Therefore, open reduction with internal fixation should be adopted. For fractures of the radius, anatomical reduction and rigid internal fixation must be achieved, using a compression plate placed on the volar surface of the radius. Postoperatively, a short-arm plaster splint is applied with the forearm in a neutral rotation position for immobilization lasting 4–6 weeks. Functional exercises begin after immobilization is removed.

For old Galeazzi fractures, if the radius has already healed but exhibits grade I malalignment with symptoms such as restricted forearm rotation and pain, resection of the ulnar head should be performed to improve rotational function and alleviate symptoms. In cases of severe deformity, correction of the deformity is necessary, along with bone grafting and fixation using a plate and screws. If the internal fixation is sufficiently stable, resection of the ulnar head can be performed simultaneously; otherwise, it should be done after the radius fracture has healed. Postoperatively, no external fixation is applied, and early forearm rotation exercises are initiated.