Galeazzi Injury

A Galeazzi injury refers to a fracture of the distal third of the radius associated with dislocation or disruption of the distal radioulnar joint (DRUJ). It is an unstable forearm injury that requires accurate recognition and appropriate management. In adults, Galeazzi injuries almost always require surgical fixation due to the inherent instability of the DRUJ after radial fracture.

This injury pattern is often described as the “fracture of necessity” because operative treatment is typically required to restore forearm stability and function. Failure to recognize the associated DRUJ injury may lead to chronic wrist instability, pain, and loss of forearm rotation.

The distal radioulnar joint (DRUJ) is a pivot joint that allows pronation and supination of the forearm. Stability of the DRUJ is maintained by several important structures.

• Triangular fibrocartilage complex (TFCC)
• Interosseous membrane
• Distal radioulnar ligaments
• Pronator quadratus muscle

In Galeazzi injuries, disruption of these stabilizing structures leads to instability of the distal ulna relative to the radius.

• Represents approximately 3–7% of forearm fractures
• More common in adults than children
• Often associated with high-energy trauma

• Fall on outstretched hand with forearm in pronation
• Direct trauma to forearm
• High-energy road traffic accidents
• Sports injuries

The force transmitted through the radius causes fracture of the distal radius and disruption of the distal radioulnar joint.

• Pain and swelling in distal forearm
• Tenderness over distal radius
• Prominence of distal ulna
• Limited pronation and supination
• Deformity of forearm

Careful examination of the distal radioulnar joint is essential to identify instability.

• X-ray forearm including wrist and elbow
• AP and lateral wrist radiographs
• CT scan for complex injuries

Radiographic signs of DRUJ injury include widening of the joint, dorsal displacement of the ulna, and radial shortening.

Treatment differs between adults and children due to differences in bone remodeling potential and ligament stability.

• Open reduction and internal fixation of radius
• Plate fixation of radial fracture
• Assessment of DRUJ stability after fixation
• Temporary DRUJ pinning if instability persists

Once the radius is anatomically reduced, the distal radioulnar joint often reduces spontaneously.

• Closed reduction
• Immobilization in long arm cast
• Surgery rarely required

• Chronic DRUJ instability
• Malunion of radius
• Loss of forearm rotation
• Nonunion
• Post-traumatic arthritis

• Galeazzi fracture = distal radius fracture + DRUJ disruption
• Known as the “fracture of necessity” in adults
• Always assess the distal radioulnar joint
• Adults usually require ORIF