Thursday, January 3, 2008

37 - galeazzi fracture




This anteroposterior radiograph demonstrates a classic Galeazzi fracture: a short oblique or transverse fracture of the radius with associated dislocation of the distal ulna. The dislocation results from the disruption of the DRUJ (distal radio-ulnar joint). Note the prominence of the distal ulna (ulna positive variance).

Galeazzi, or Piedmont, fracture

A Galeazzi fracture results from a FOOSH mechanism with the forearm hyperpronated or from a direct impact to the dorsal radial wrist. The radial diaphysis at the distal and middle third junction is fractured, with associated subluxation of the distal radioulnar joint. On PA views, the radius is shortened and the radioulnar joint is disrupted.

Radioulnar distances greater than 2 mm are suggestive of a ligamentous injury and/or a tear of the TFC. On the lateral view, the distal radius is angulated either volarly or radially as a result of the pull of the brachioradialis muscle with more than 3 mm of ulnar displacement.An associated ulnar styloid fracture also may be present.

PA views may show a displaced radial and ulnar styloid. The lateral view may reveal the associated radioulnar dislocation that is occult on the AP view.

Classification is based on the direction of displacement of the distal fracture fragment.

Complications include radial malunion, nonunion, and persistent subluxation of the radioulnar joint.

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