![]() ![]() The radius and ulna have a mechanical dependency on one another. This precedes dissociation between the distal radius and ulna, leading to the disruption of the connecting ligaments.3 Morrissy, et al noted that this pattern of injury occurs in one of two ways: either the hand is fixed and the body is rotating (e.g., an active fall on an out-stretched hand) or the body is fixed and the hand is rotating (e.g., getting a hand caught in a piece of machinery).4 Both mechanisms involve extreme extension and pronation of the wrist with rotational and fixed components.4 The DRUJ is not technically disrupted, but is functionally disrupted due to the loss of its anchoring on the main body of the ulna.2Įxtreme pronation and extension transmit a great amount of force across the wrist and result in a fracture and shortening of the distal radius. A distal ulnar physis fracture can occur due to the relative weakness of the growth plates. This disruption makes for an unstable fracture, as the brachioradialis, pronator quadratus, thumb abductors and extensors, and the weight of the hand act on the distal portion of the radius and therefore distract it.2Ī Galeazzi equivalent may occur in children. The DRUJ disruption occurs through interruption of the articular disc and the distal dorsal and volar radioulnar ligaments, especially the triangular fibrocartilage. The majority of the fracture sites occur between the radial insertions of the pronator teres and pronator quadratus.1 ![]() Note that the overlap of the radius and ulna appears to be compromised.Ī Galeazzi fracture is a distal radius fracture with disruption of the radioulnar joint. The radial fracture is unicortical and there is no shortening of the shaft.įigure 1b. Due to the tenderness over the DRUJ, the diagnosis of a Galeazzi fracture with some degree of disruption of the ligaments maintaining the DRUJ was entertained.įigure 1a. The growth plates were still open and no ulnar fracture was seen. Plain radiographs of the patient’s left wrist and forearm revealed a non-displaced unicortical fracture of the distal third of the radius ( Figures 1a and 1b). He was able to move his wrist through a full range of motion in all directions without assistance. His left elbow and shoulder had full, painless range of motion. His pulses were normal and sensation was intact. He had no tenderness to palpation in his fingers, hand, snuffbox, elbow, humerus, or shoulder. The patient’s left wrist was mildly swollen and tender to palpation over the distal radius and ulna, and over the dorsal, distal radial-ulnar joint (DRUJ) region. The facial and extremity lacerations were healing well without evidence of infection. On exam, he was afebrile, and vital signs were within normal limits. Two days later, the patient returned complaining of left wrist and forearm pain. He was observed overnight in the pediatric trauma unit and discharged the next day. He sustained multiple lacerations of his mid-face, left shoulder, and right lower extremity several of these wounds required suturing. The patient was unsure as to where he was struck, how he landed, and whether or not he lost consciousness. However, in certain situations this joint may be compromised with certain rotational forces.Ī 14-year-old African-American male was struck by a motor vehicle while walking. ![]() The anatomic structure of the forearm typically maintains the integrity of the distal radioulnar joint when the radius is fractured. Nonetheless, a high index of suspicion is required for the diagnosis of a Galeazzi fracture–dislocation.īy Heather L Hinshelwood, MD and David Caro, MD Urgent message: Fractures of the distal radius are a common presentation in the urgent care setting. ![]()
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