The document provides a comprehensive overview of Galeazzi fractures, which involve a fracture of the distal or middle third of the radius along with dislocation of the distal radioulnar joint (DRUJ). It discusses the mechanisms of injury, diagnosis, treatment options, and pre-operative planning, including various surgical approaches and classification of fractures based on their stability. Key factors such as imaging findings, assessment of the DRUJ, complications, and optimal timing of surgery are also addressed.

1. TECHNICAL OPERATION
FOR GALEAZZI FRACTURE
By: dr. PANJI

2. •Bones of Forearm

4. Definition
• The combination of fracture of the distal or middle
third of the shaft of the radius and dislocation of the
distal radioulnar joint.
• counterpart of the Monteggia fracture-dislocation
• also known as a reverse Monteggia fracture.

5. Introduction
Distal 1⁄3 radial shaft fracture, shortening forces result in distal radioulnar dislocation
Mechanism: fall on outstretched hand
By mechanism:
Pronation: Galeazzi
Supination: Reverse Galeazzi (ulna shaft fx with DRUJ dislocation)
Netter’s conscise of Orthopaediics

6. Diagnosis
• fracture of the radius (usually at junction of middle and distal thirds), with distal radioulnar joint (DRUJ)
instability
• DRUJ instability :
• DRUJ is unstable in 55% of patients in whom the radial fracture is
less than 7.5 cm from the articular surface.
• DRUJ is unstable in 6% of patients in whom the radial fracture is
more than 7.5 cm away from the articular surface.
• Signs of DRUJ instability include ulnar styloid fracture, widened
DRUJ on posteroanterior view, dislocation on lateral view, and 5
mm or more of radial shortening.
• Miller's Review of Orthopaedics 8th

7. Classification
• They are subclassified according to the distance of the radial fracture
from the articular surface.
• Type 1 fractures : within 7.5 cm of the articular surface of the distal
radius, and type 2 more proximally.
• The relevance of this classification lies in that type 1 are associated
with a significantly higher rate of instability of the DRUJ
• DRUJ Dislocation :
• Simple : automatically reduced after radial allinment restored
• Complex : irreducible
• Interposition of the ECU and EDM between the distal radius and ulna
have been described as causes for DRUJ irreducibility
• Rockwood and Green's Fractures in Adult 9th

8. 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)
Ramisetty, NM; Revell, M; Porter, KM (2004). Galeazzi fractures in adults. Trauma, 6(1), 23–28.

9. Treatment
• ORIF of the radius followed by supination of the forearm and assessment of the DRUJ.
• Reduced and stable: protective splint and early motion
• Reduced and unstable
• Large ulnar styloid fragment: ORIF of styloid and immobilization in supination.
• No fragment: ulna pinned to radius and immobilized in supination.
• Irreducible
• Most commonly due to interposition of extensor carpi ulnaris tendon
• DRUJ approached via dorsal incision for removal of block.
•Miller's Review of Orthopaedics 8th

10. Assessment of
Distal Radioulnar
Joint (DRUJ)
• Before starting the operation the uninjured
side should be tested as a reference for the
injured side.
• After fixation, the distal radioulnar joint
should be assessed for forearm rotation, as
well as for stability. The forearm should be
rotated completely to make certain there is
no anatomical block.
• Method 1
• The elbow is flexed 90° on the arm table and
displacement in dorsal palmar direction is
tested in a neutral rotation of the forearm
with the wrist in neutral position.
• This is repeated with the wrist in radial
deviation, which stabilizes the DRUJ, if the
ulnar collateral complex (TFCC) is not
disrupted.
Source : AO Surgical Reference

11. • Method 2
• In order to test the stability of
the distal radioulnar joint, the
ulna is compressed against the
radius.
This is repeated with the wrist in full supination and full
pronation.
Source : AO Surgical Reference

12. while the forearm is passively put through full supination.
...and pronation.
If there is a palpable “clunk”, then instability of the distal radioulnar joint should be
considered. This would be an indication for internal fixation of an ulnar styloid
fracture at its base. If the fracture is at the tip of the ulnar styloid consider TFCC
stabilization.
Source : AO Surgical Reference

13. Reduction & stabilization of DRUJ
• immobilization in supination (6 weeks)
• indicated if DRUJ stable following ORIF of radius
• percutaneous pin fixation
• indicated if DRUJ reducible but unstable
following ORIF of radius
• cross-pin ulna to radius. leave pins in
place for 4-6 weeks
• open surgical reduction
• indicated if reduction is blocked.
Suspect interposition of ECU tendon
• open reduction internal fixation
• indicated if a large ulnar styloid fragment exists
• fix styloid and immobilize in supination
Ramisetty, NM; Revell, M; Porter, KM (2004). Galeazzi fractures in adults. Trauma, 6(1), 23–28.
Alajmi, Turki. (2020). Galeazzi Fracture Dislocations: An Illustrated Review. Cureus. 12. 10.7759/cureus.9367.

14. Complication
• Malunion/nonunion and DRUJ subluxation
• Compartment syndrome
• Neurovascular injury
• Refracture
• Nonunion
• Malunion
Miller's Review of Orthopaedics 8th

15. •Algorithm

16. Pre operative planning
(Surgical preparation)
• The patient is usually placed supine with the
affected limb supported on an arm rest or a
hand table.
• If a tourniquet is used, it should be as
proximal as possible on the upper arm to
provide for additional space if the incision
needs to be extended proximally.
• Some surgeons only inflate the tourniquet if
severe bleeding occurs during surgery.
Source : AO Principles of Fracture Management

17. Pre operative planning
(Timing of surgery)
• Closed forearm fractures are best operated on within the first 24
hours following the injury.
• Open fractures should urgently undergo debridement and irrigation
and fixation.
• Prolonged delay in fixation may increase the risk of radioulnar
synostosis
• Attempting to fix both bones through a single approach increases the
risk of nerve injury and radioulnar synostosis; it is not recommended
Source : AO Principles of Fracture Management

18. Pre operative planning
(Implant Selection)
• A plate 3.5 is the ideal size for forearm bones.
• In general, we recommend the limited-contact dynamic
compression plate
• There should be 6 cortices or 3 bicortical screws in each
main fragment.
• In simple fractures this usually means a 7-hole or 8-hole
plate; in more complex fractures even longer plates are
advisable.
Source : AO Principles of Fracture Management

19. Approach to the ulna
• Length of the incision depends on the exposure needed, it can be extended both proximally and distally.
• Incision : between the tip of the olecranon process and the ulnar styloid process
• A deep dissection in the interval between the FCU and ECU
Source : AO Surgical Reference

20. Henry Approach
• The landmarks for the skin incision are:
• Proximal
• The biceps tendon, which crosses the front of the elbow joint, medial to the
brachioradialis.
• The “mobile wad”, formed from the brachioradialis and the extensors carpi radialis brevis
and longus
• Distal
• The radial styloid process.
Source : AO Surgical Reference

21. Source : AO Surgical Reference

22. Source : AO Surgical Reference

23. • Deep dissection - distal third
• partially supinate the forearm
• dissect the periosteum off the
lateral aspect of the distal third of
the radius, lateral to the pronator
quadratus and flexor pollicis
longus
Source : AO Surgical Reference

24. • Posterior interosseous nerve
• enters the supinator muscle beneath a fibrous arch known as the arcade of
Frohse
• the arch is formed by the thickened edge of the superficial head of the
supinator muscle
• compression of the nerve at this point produces paralysis or dysfunction
of the extensors known as posterior interosseous nerve entrapment
syndrome
• step to protect the PIN include
• dissecting supinator off radius subperiostally
• do not place retractors on posterior surface of radial neck
• avoid excessive radial retraction of supinator
• injury
• injury leads to a neuropraxia that takes 6-9 months to resolve
Source : AO Surgical Reference

25. • Superficial radial nerve
• runs down forearm under body
of brachioradialis
• vulnerable with manipulation
of mobile wad of three
• damage to it can cause a
painful neuroma
• Radial artery
• runs down middle of forearm
under brachioradialis
Source : AO Surgical Reference

26. Modified Henry Approach
Source : AO Surgical Reference

27. Posterolateral approach (Thompson)
• The posterolateral (Thompson) approach offers good exposure of the
middle and distal thirds of the radial shaft.
• The landmarks for skin incision are:
• Proximally: the lateral epicondyle
• Distally: Lister’s tubercle
Source : AO Surgical Reference

28. References
• Apley’s System of Orthopaedics and Fractures 9 th Edition
• Campbells Orthopedics, 13th edition
• AO Surgical Reference
• Rockwood and Green’s Fractures in Adults. Eighth. Wolters Kluwer Health; 2015
• Hoppenfeld S Boer P de Buckley R. Vías De Abordaje De Cirugía Ortopédica. Un Enfoque Anatómico. 5th ed.
Wolters Kluwer; 2018.

29. THANK YOU