Paediatric Galeazzi Fracture-Dislocation
A Galeazzi fracture-dislocation is a fracture of the distal third of the shaft of the radius with a disruption to the DRUJ.
Galeazzi fracture-dislocations are very rare in children and are often missed and may be difficult to recognize. If there is an isolated radius fracture, always examine the distal radioulnar joint (DRUJ) on x-ray.
More common is the Galeazzi equivalent, where there is a distal radius fracture with a distal ulna physeal fracture but without disruption of the DRUJ.
Galeazzi fracture-dislocation can be classified by the direction of the ulna displacement:
The most common mechanism is a fall on an outstretched hand with forearm rotation.
There will be swelling at the distal forearm and/or wrist. The forearm and wrist will be painful to move.
On examination, the deformity through the forearm is usually clinically evident. Rotation of the forearm is painful and restricted. The ulnar styloid process may be palpable and displaced from its normal position in the direction of dislocation—dorsal or volar.
All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified.
Anteroposterior (AP) and lateral x-rays of the forearm that include the wrist and elbow should be ordered.
Galeazzi fracture-dislocations are often missed and may be difficult to recognize. If there is an isolated radius fracture, always examine the DRUJ on x-ray.
The reduction is always required and is urgent. This is usually performed in theatre under a general anaesthetic.
For children, most of these fractures can be managed with closed reduction. Fluoroscopy should be used to assess the stability of the DRUJ after reduction.
Adolescents are more likely to need open or percutaneous fixation to stabilize the DRUJ after reduction.
Open treatment is indicated when anatomic reduction cannot be obtained or maintained by closed methods. If the radius cannot be maintained in a reduced position, the ulnar styloid will often dislocate when the radial fracture displaces. In most cases, stabilizing the radius fracture will keep the ulnar styloid reduced. Radial fixation can be accomplished with pins or plates & screws.
Emphasis should be placed on the elevation of the limb (elbow above the heart) for the first 48 hours and active finger mobilization.
Back slab and sling should be worn under clothing and not through the sleeve.
The majority of these fractures will do well. Poor outcomes are usually a result of a delayed diagnosis or if the forearm has been immobilized in an incorrect position or a below-elbow cast.
Delayed diagnosis is a frequent complication. Treatment after delayed diagnosis is much more complex and the outcomes are much less satisfactory.
Nerve injury is uncommon, but cases have been reported with injuries to the ulnar nerve. This usually resolves with observation.
There is a high risk (≤55%) of ulnar physeal injury with Galeazzi equivalent injuries. This can lead to ulna shortening and issues with the DRUJ, depending on the amount of growth remaining in the radius.
Malunion of the radius can cause subluxation of the DRUJ. This can lead to pain and loss of motion through the forearm and wrist.