According to Walsh, outcomes following nonoperative management for pediatric Galeazzi fractures are good. Ĭampbell describes this injury as a fracture of necessity because of the complex nature of the injury that required surgical fixation in the adult population to achieve a good functional outcome. Salvage techniques such as sauve-kapandji, darrach procedures have been described in the literature for chronic unstable distal radioulnar joint. Patients with chronic malunited radius with the instability of distal radio ulna joint presented with chronic pain, swelling, instability, limited rotational movement at the wrist, and loss of grip strength. Malunion with a chronic instability to the distal radioulnar joint is often due to missed diagnosis or inappropriate treatment. Ĭomplications like median nerve neuropathy, Nonunion, malunion, infection are rare. Ulnar styloid fracture and triangular fibrocartilage complex injuries are the commonest problems associate with the unstable distal radio ulna joint which also need to be addressed during surgery. Irreducible distal radioulnar joint needs open reduction and fixation through the dorsal approach. Stable distal radio ulna joint can be immobilized with a long arm cast for three weeks. Īfter osteosynthesis, an intraoperative examination of the distal radial ulna joint should be performed to assess the stability of the joint. In children, manipulation under anesthesia and above the elbow, cast immobilization provides successful results whereas, in adults, an open reduction and internal fixation are required to achieve good results. The definitive management varies again with the age of the patient. In addition, initial management also includes splinting and providing adequate analgesia. The initial evaluation should include ATLS protocol in suspected patients to exclude other life-threatening injuries. Children and elders will present with simple falls, adults will present following a history of high-speed motor vehicle accidents or sports injuries. The presentation may vary according to the age of the patient. Galeazzi fractures are classified initially by the mechanism of injury and position of distal radius by Walsh. The junction between the middle and distal third of the radius is more vulnerable to fracture because of peculiar characteristics of cross-sectional properties of cortical bone and the distribution of mineral contents at this site. The distal radius fracture with a high-velocity injury disturbed the triangular fibrocartilage and dislocate the distal radioulnar joint. Length variation following fracture of one of these bones may cause instability of both joints. The distal radio-ulna joint is stabilized mainly by the triangular fibrocartilage. Bilateral Galeazzi fractures can be associated with high-velocity motor vehicle accidents, which warrants exclusion of life-threatening and limb-threatening injuries according to the ATLS protocol.īoth proximal and distal radio-ulna joints move together as radius and ulna bones are tightly bound together by interosseous membrane ligament complex. It has a bimodal distribution among children (3%) and adult populations (7%). It is also described as a reverse Monteggia fracture in literature. Galeazzi fracture is an uncommon injury among forearm fractures.
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