This patient is a 34-year-old Thai man who was in a motorcycle accident and injured his right arm. He has a Galeazzi fracture of his right forearm, which involves a fracture of the distal radius shaft with an associated injury to the distal radioulnar joint. The patient will undergo surgery to reduce and stabilize the fracture with a plate and screws. Post-operatively, he will be placed in a cast and undergo physical therapy to regain range of motion. Follow-up x-rays will monitor healing of the fracture over several months.

1. conference

2. case
PF : ผู้ป่วยชายไทยคู่อายุ 34 ปี ภูมิลาเนาจังหวัด โคราช
CC: ขับ MC ล้ม 2 ชม PTA

3. Present illness
-2 ชม ก่อนมารพ ขับ รถ MC เกิดอุบัติเหตุล้ม มือขวายันพื้น หลังจากนั้น
เจ็บที่แขนด้านขวา ปวดมาก ขยับแล้วเจ็บมาก ไม่มีแผลเปิด สวมหมวกนิรภัย
ไม่มีสลบ จาเหตุการณ์ได้ตลอด
ไปรักษา ที่ รพช พบมีกระดูกหัก ใส่ arm sling แล้ว refer มาที่ รพ
มหาราช

4. Past history : no underlying disease
Personal history : no Hx smoking or alcohol used

5. Physical examination
V/S : BP 120/70 ,T 37 C ,RR 16 /min ,HR 80 bpm
GA: good consciousness
Heart & lung : WNL
Abdomen : soft , not tender
EXT : deformities and palpable stepping Rt arm
capillary refill < 2 sec ,nerve intact ,limited ROM Rt
arm due to pain
Can’t supination and pronation right arm

6. Film

7. Film

8. Management ER
CBC ,Anti –HIV
-Long arm post. Slab
-Film Rt. Forearm AP , Lat
-Control pain

9. diagnosis
Galeazzi fracture

10. Management
Set OR for ORIF with plate and screw

11. Galeazzi fracture

12. Definition
◦distal 1/3 radius shaft fx AND
◦associated distal radioulnar joint (DRUJ)
injury
Mechanism
◦direct wrist trauma
◦typically dorsolateral aspect
◦fall onto outstretched hand with forearm in
pronation

13. Presentation
Symptoms
◦ pain, swelling, deformity
Physical exam
◦ point tenderness over fracture site
◦ ROM
◦ test forearm supination and pronation for
instability
◦ DRUJ stress
◦ causes wrist or midline forearm pain

14. Imaging
Radiographs
◦ recommended views
◦ AP and lateral views of forearm, elbow, and wrist
◦ findings
◦ signs of DRUJ injury
◦ ulnar styloid fx
◦ widening of joint on AP view
◦ dorsal or volar displacement on lateral view
◦ radial shortening (≥5mm)

15. Treatment
◦ORIF of radius with reduction and
stabilization of DRUJ
◦indications
◦all cases, as anatomic reduction of DRUJ
is required
◦acute operative treatment far superior
to late reconstruction

16. Complications
Compartment syndrome
◦ increased risk with
◦ high energy crush injury
◦ open fractures
◦ vascular injuries or coagulopathies
◦ diagnosis
◦ pain with passive stretch is most sensitive
Neurovascular injury
◦ uncommon except type III open fractures
Nonunion
Malunion
DRUJ subluxation
◦ displaced by gravity, pronator quadratus, or brachioradialis

17. Complications
Refracture
◦ usually occurs following plate removal
◦ increased risk with
◦ removing plate too early
◦ large plates (4.5mm)
◦ comminuted fractures
◦ persistent radiographic lucency
◦ prevention
◦ do not remove plates before 18 months after insertion
◦ amount of time needed for complete primary bone
healing

18. Long-Term Monitoring
At 7 and 14 days after surgery, the wound is
examined. Remove the sutures 10-14 days
after surgery, obtain radiographs at each visit,
and replace the splint with an above-elbow
cast brace in supination.
At 4 weeks, obtain radiographs to recheck
alignment and reduction of the radius and the
DRUJ, remove pins if present, recheck
radiographs to confirm maintenance of
reduction, and replace the cast brace in
supination.

19. Long-Term Monitoring
At 6 weeks, remove the cast, obtain radiographs,
and initiate physical therapy for elbow, wrist, and
digital motion. Application of a functional forearm
brace is appropriate at this time.
Reexamine radiographs at 6-week intervals until
healing is apparent.