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Galeazzi Fracture: Causes, Symptoms & Treatment

A Galeazzi fracture is a forearm injury combining a radial shaft fracture with dislocation of the distal radioulnar joint at the wrist.

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A Galeazzi fracture is a forearm injury combining a radial shaft fracture with dislocation of the distal radioulnar joint at the wrist.

What Is a Galeazzi Fracture?

A Galeazzi fracture is a specific and complex forearm injury defined by two simultaneous components: a fracture of the radial shaft (the radius bone) in its middle to distal third, combined with a dislocation of the distal radioulnar joint (DRUJ) – the joint connecting the radius and ulna at the wrist. This combination makes the injury mechanically unstable and nearly always requires surgical treatment. The condition is named after Italian surgeon Ricardo Galeazzi, who provided a systematic description of the injury in 1934.

Causes

Galeazzi fractures typically result from indirect force applied to the forearm or wrist, most commonly during a fall. Common causes include:

Falls onto an outstretched hand
Direct blows to the forearm, such as in sporting accidents
Motor vehicle accidents
Occupational injuries involving mechanical force

The injury is more common in adults than in children, as similar forces in children tend to produce different fracture patterns, such as greenstick fractures.

Symptoms

Typical signs and symptoms of a Galeazzi fracture include:

Pain along the forearm and wrist
Swelling and possible bruising over the fracture site
Visible deformity of the forearm or wrist
Restricted movement, especially pronation and supination (inward and outward rotation of the forearm)
Tenderness on palpation over the fracture and the distal radioulnar joint

Diagnosis

Diagnosis is established through clinical examination and imaging:

X-ray of the forearm in two planes (anteroposterior and lateral), including the wrist and elbow – this is the standard diagnostic approach
Imaging typically reveals the radial shaft fracture alongside widening of the DRUJ space or ulnar dislocation
In complex or unclear cases, computed tomography (CT) or magnetic resonance imaging (MRI) may provide additional diagnostic information

Treatment

Surgical Treatment (Standard in Adults)

In adults, a Galeazzi fracture is almost always an indication for surgery. Conservative management with casting frequently leads to re-displacement and poor outcomes in adults. Surgical treatment typically involves:

Open reduction and internal fixation (ORIF) of the radial shaft using plate osteosynthesis (most commonly a volar or dorsal plate)
After stable fixation of the radius, the DRUJ is tested for stability. If stable, no additional fixation is required.
If the DRUJ remains unstable, additional Kirschner wire fixation or repair of the ulnar ligamentous complex may be performed

Conservative Treatment (In Children)

In selected pediatric cases, closed reduction and immobilization in a cast can be successful, due to the greater remodeling potential of the growing skeleton.

Aftercare and Rehabilitation

Following surgery, a period of immobilization is required, after which physiotherapy is initiated to restore range of motion, forearm rotation, and grip strength. Full rehabilitation may take several months.

Prognosis

With prompt and appropriate surgical management, the prognosis of a Galeazzi fracture is generally favorable. Untreated or inadequately treated injuries can lead to chronic wrist instability, persistent pain, and permanent limitation of forearm rotation. Potential complications include nerve or vascular injury and post-traumatic arthritis of the distal radioulnar joint.

References

Nicolaidis SC, Hildreth DH, Lichtman DM. – Acute injuries of the distal radioulnar joint. Hand Clinics, 2000; 16(3): 449–459.
Rettig ME, Raskin KB. – Galeazzi fracture-dislocation: a new treatment-oriented classification. Journal of Hand Surgery, 2001; 26(2): 228–235.
Rockwood CA, Green DP (eds.) – Rockwood and Green's Fractures in Adults. 8th edition. Wolters Kluwer Health, 2014.

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