This document discusses the treatment of Galeazzi fractures, which involve a break in the distal third of the radius bone along with dislocation of the distal radio-ulnar joint. It outlines the evaluation, surgical approaches, techniques for open reduction and internal fixation using plates or pins, post-operative care, and potential complications. The prognosis depends on factors like the timing of surgery and whether the radius fracture and joint dislocation are properly reduced.

1. BY
LATHA.VK
DHZ…

2. Conservative and surgical
management of galeazzi
fracture,
Complication
Prognosis

3.  The combination of the distal third of the
shaft of the radius and dislocation of the
distal radio-ulnar joint was called “the
fracture of necessity”
 This injury is the counterpart of the
MONTEGGIA fracture.

4.  Initial evaluation of the patient & the
radiographs is necessary for developing
a treatment plan.
 A detailed history related to mechanism
of injury, hand
dominance, occupation, previous injury
& associated medical problem is re
equipped.
 Examine the entire extremities for
associated injuries.

5.  INSPECTION: identify the presence of
open #.Assess the extent &severity of soft
tissue injury.Ecchymosis,fracture
blister, edema denotes suspicion of
COMPARTMENT SYNDROME.
 PALPATION: Tenderness& instability should
performed from shoulder to hand.
Neurological examination should focused
include motor sensory status of radial
(post.interosseous,superficial
radial), ulnar, median nerves. Vascular
examination also focus-palpate pulses.

6.  Radio graph: AP & lateral view of elbow and
wrist.
 A treatment regimen of closed reduction &
cast immobilization has high unsatisfactory.
 Open reduction of the radial shaft fracture
through anterior approach & internal fixation
with 3.5mm AO dynamic compression plate
is the treatment of choice in adults.
 If this joint is still unstable, it should be
temporarily transfixed with kirschner wire with
forearm supination. wire is removed after
6wks. Radial shaft # too distal to allow
fixation with intra medullary device.

7. 1.General anesthesia can be utilized.
The patient is positioned supine & arm is
placed on a radiolucent arm board.
2.Surgical incision drawn on the
extremity, and # site is localized.
3.Loop magnification may utilized &
control bleeding.

8. SURGICAL APPROCHES:
1. FLEXOR CARPI RADIALIS APPROACH
Surgical incision is located just radial to FCR
Tendon. Splits the sheath longitudinally & FCR
tendon is retracted ulnarly. Then
Flexor pollicis longus(FPL) is encountered&
retracted ulnarly.pronater quadrates is
Incised elevated from periosteum & retract

9. To expose distal third of radius.This exposure
Offers the benefit of avoiding direct dissection
Of radial artery. which FCR sheath protects.

10. Most often use to exposure the radius surgical
incision is just lateral to the FCR tendon.i.e
biceps tendon to radial styloid. Pierce the
fascia emerges on the superficial surface of
Brachioradialis. deep dissection distally incising
the pronater quadrates &retracted
Ulnarly along with FPL .

11.  The distal third of radial shaft is exposed
with retraction of bracioradialis radially &FCR
Medially.
 Pronater teres has been elevated sharply
to expose the middle third of radius.

12.  The Henry approach can be extended to
the proximal third of radius if needed. The
probe shows the insertion of the bicipital
tendon.

13.  Described by THOMPSON. It provide
access to the posterior aspect of radius.
 In experience it is less suited if the
extension to the distal third of radius.
 In this distal 3rd abductor pollicis longus &
extensor pollicis brevis muscle cross the
surgical field.
 In proximal 3rd approach is limited by
supinator with the enclosed of PIN.
 It may be useful in posterior interosseous

14. Nerve palsy when the nerve to be explored.
If in this case the supinator canal can be split
in order to expose the entire length of the
nerve.

15.  Internal fixation with plates allows
excellent control of fracture fragments
and permits accurate restoration of the
anatomy.
 The fracture is reduced with the aid of
sharp or broad fracture reduction
forceps and manual traction.C-arm
radiographic visualization can be used
to confirm fracture/bone alignment.

16.  3.5mm AO dynamic compression
plate(DCP),limitated contact-dynamic
compression plate(LC-DCP) are used, which
provide more secure fixation.
 The concept of limited contact between the
plate& bone has development of point
contact-fixator(PC-Fix).
 The screws of pc-fix have conical heads to fit
identically formed fixator holes
exactly, therefore giving them angular
stability.
 The pc-fix &the later locking compression
plates(LCP) were designed to be used with
unicortical screws.

17. The plate must be accurately centered over
the reduced fracture & must be of
sufficient length to permit a minimum of
4, preferable 6 cortices secured by screws
on each side of fracture.

19.  Evaluate fracture and DRUJ for realignment
&reduction.
 Rotate the forearm and assess for any DRUJ
instability.
 If the DRUJ is stable, specifically evaluate in
supination.
 We do not advise routine removal of
forearm plates. Remove only if they cause
symptoms because of their subcutaneous
location.
 Once a plate has been removed, forearm
should protected by splint for 6 wks.

21.  If DRUJ is reducible in supination,stabilize
by placing two 0.045 kirschner wires(k-
wires) from the ulna into the radius, just
proximal to the articular surface.
 Bone graft may be applied to grossly
comminuted #.but routine grafting is not
indicated..
 Check the reduction with radiographs.
 Irrigate and close wounds.
 Apply a long arm splint with the forearm
placed in supination.

23.  Elevate the upper extremity.
 Apply ice to the operative site as needed
 Check neurologic and vascular status.
Specifically, evaluate for function of the
AIN and for the presence of
COMPARTMENT SYNDROME
 Immobilize the forearm in supination for 4
wks with removal of any percutaneous
pins at 4th wk
 Immediately after surgery, institute
occupational therapy for digital&
shoulder range of motion.

24.  AFTER SURGERY:
 7&14th day-wound examined
 10-14th day-remove suture
 4th wk-obtain radiograph to recheck
Alignment & remove pins if present.
 6wk-physical therapy.
Reexamine radiographs.

25.  Over all complication rate in treatment of
galeazzi # approaches 40%.complication
include following:
1.nonunion
2.malunion
Are primarily associated with inadequate
plate
fixation.

26. 3.infection
4.compartment syndrome-major
complication. there are 3 compartment
1.flexor,2.extensor,3.mobile wad(brachio
Radialis& extensor carpi radialis longus and
Brevis).
SIGN: increased pain , which can be
tested passively stretching the fingers.
PATHOLOGY: hypoxia followed by swelling
which reduce the perfusion pressure at the
capillary level, leading to ischemic muscle
and myonecrosis.another way direct muscle
Damage-increased intra compartmental
pressure

28. 5. Re- fracture following plate removal
6.PIN injury
7.instabilty of the DRUJ
PROGNOSIS:
It influence of the timing of surgery, due
to delayed diagnosis in relation to the time
Of injury,# associated with complication-
WORST OUTCOME…
The proper reduction of radius with
concomitant reduction of DRUJ-EXCELLENT
OUTCOME…