Galeazzi Fracture: Causes, Diagnosis, and Treatment

Overview

What is a Galeazzi fracture?

A Galeazzi fracture is a specific type of fracture involving two key elements:

• Fracture of the Distal Radius: The Galeazzi fracture features a break in the distal (lower) end of the radius bone, one of the two main bones in the forearm. This fracture occurs near the wrist.
• Dislocation of the Distal Radioulnar Joint: Along with the radius fracture, there is a dislocation at the distal radioulnar joint, this is where the distal (at the wrist) ends of both the radius and ulna bones meet near the wrist.

Understanding Galeazzi Fracture

Anatomy of the Forearm and Wrist:

• Forearm Bones:
  1. Radius: The radius is the bone on the thumb side of the forearm. It is the primary bone involved in the Galeazzi fracture.
  2. Ulna: The ulna is the bone on the pinky side of the forearm. It runs parallel to the radius.
• Distal Radius: The distal radius is the part of the bone, called the radius, that is closest to the wrist. It is where the fracture occurs in a Galeazzi fracture.
• Distal Radioulnar Joint: This joint is located at the distal end of the forearm, near the wrist, where the radius and ulna meet. In a Galeazzi fracture, it is dislocated, affecting the wrist’s stability and function.
• Wrist Structure:
  1. Carpal Bones: These are the eight small bones that make up the wrist and connect the forearm to the hand.
  2. Ligaments: These are the connective tissues that stabilise the wrist and help maintain joint integrity.

Types of Galeazzi Fractures: Galeazzi fractures can vary in terms of severity and complexity. Although the classification system isn’t as elaborate as some other fractures, Galeazzi fractures generally fall into categories based on the nature of the fracture and dislocation:

• Type I: Simple Fracture with Stable Dislocation
  1. Fracture: Simple break in the distal radius without severe fragmentation.
  2. Dislocation: The distal radioulnar joint dislocation is not severe or complicated.
  3. Treatment: Often involves closed reduction and immobilisation, but surgical intervention may be needed for better alignment.
• Type II: Complex Fracture with Unstable Dislocation
  1. Fracture: More complex or comminuted fracture of the distal radius with multiple fragments.
  2. Dislocation: More severe or unstable dislocation of the distal radioulnar joint.
  3. Treatment: Typically requires surgical intervention to stabilise both the fracture and the dislocated joint.
• Type III: Associated Injuries
  1. Fracture: Includes additional injuries such as fractures of the carpal bones or other associated joint injuries.
  2. Dislocation: Distal radioulnar joint dislocation with complicating factors.
  3. Treatment: Requires comprehensive management involving surgical correction, stabilisation, and possibly repair of associated injuries.

Prevalence and Epidemiology

How Common are Galeazzi Fractures?

Galeazzi fractures are relatively uncommon compared to other types of fractures, particularly in the general population. They are considered less frequent than fractures like those of the distal radius alone or simple wrist fractures. However, they are recognised in trauma settings, especially where significant force is involved.

Who is Most at Risk for Galeazzi Fractures?

• Active Individuals and Athletes:
  • Contact Sports: People involved in contact sports, such as football, rugby, or hockey, are at higher risk due to the likelihood of falls and direct trauma to the forearm and wrist.
  • High-Impact Activities: Activities that involve high-impact or falls, such as skateboarding or skiing, also increase the risk.
• Children and Adolescents:
  • Growth Spurts: Children and adolescents, especially those in the midst of growth spurts, are more prone to fractures due to the relative fragility of their growing bones and the high energy involved in play and sports.
• Elderly Individuals:
  • Osteoporosis: Older adults, particularly those with osteoporosis or weakened bone density, are at increased risk of fractures from falls. Osteoporotic bones are more susceptible to fractures, including Galeazzi fractures.
• Individuals with High-Risk Occupations:
  • Construction Workers and Manual Laborers: Those who engage in manual labour or work in high-risk environments are more susceptible to traumatic injuries, including fractures involving the radius and wrist.
• Patients with Osteopenia/Osteoporosis:
  • Bone Density Issues: Individuals with conditions that affect bone density, such as osteopenia or osteoporosis, may have a higher risk of fractures under stress or trauma, including Galeazzi fractures.

Symptoms and Causes

What Causes Galeazzi Fractures?

Galeazzi fractures are typically caused by significant trauma or force applied to the forearm and wrist. Common causes include:

• Falls on an Outstretched Hand: This is the most frequent cause. When a person falls and tries to catch themselves with their hand, the impact can transmit force to the wrist, causing a fracture in the distal radius and a dislocation of the distal radioulnar joint.
• Direct Trauma: Blunt force or impact to the forearm, such as from a car accident or a direct blow, can result in both a radius fracture and dislocation of the distal radioulnar joint.
• Sports Injuries: High-impact sports or sports that involve falls or direct contact, such as football, rugby, or skiing, can lead to Galeazzi fractures due to the forces exerted on the forearm and wrist.
• Industrial or Occupational Accidents: Accidents in high-risk jobs or industries, such as construction, where heavy objects or machinery might cause trauma to the forearm, can also result in these fractures.

What Are the Symptoms of a Galeazzi Fracture?

The symptoms of a Galeazzi fracture can be quite pronounced and include:

• Severe Pain: Intense pain localised to the wrist and forearm, which may worsen with movement or pressure.
• Swelling: Significant swelling around the wrist and forearm, which may increase over time.
• Deformity: Visible deformity or abnormal angling of the wrist or forearm. The wrist may appear deformed due to the fracture and dislocation.
• Bruising: Bruising around the wrist and forearm, which can develop as a result of the injury and the associated bleeding.
• Limited Range of Motion: Difficulty moving the wrist or forearm, often accompanied by stiffness or inability to perform normal wrist movements.
• Dislocated Wrist: The distal radioulnar joint may be visibly dislocated or misaligned, causing the wrist to appear out of place.
• Numbness or Tingling: In some cases, numbness or tingling may be felt in the hand or fingers, indicating possible nerve involvement or compression.
• Functional Impairment: Difficulty performing everyday tasks that involve the use of the wrist and hand due to pain, swelling, and limited movement.

If you experience symptoms suggestive of a Galeazzi fracture, it’s crucial to seek medical attention from a medical team that specialises in orthopaedic care for an accurate diagnosis and appropriate treatment. Access Ortho specialist orthopaedic provides care for acute limb injuries.

Diagnosis and Tests

How Are Galeazzi Fractures Diagnosed?

Diagnosing a Galeazzi fracture involves a combination of clinical evaluation and imaging studies. The process generally includes:

• Medical History and Physical Examination:
  • History: The doctor will ask about the mechanism of injury (e.g., fall on an outstretched hand, direct trauma) and any symptoms experienced.
  • Physical Examination: The medical team will assess the wrist and forearm for signs of pain, swelling, deformity, and limited range of motion. They will also check for any signs of dislocation at the distal radioulnar joint.
• Assessment of Symptoms:
  • Symptoms such as severe pain, swelling, deformity, and difficulty moving the wrist and forearm will guide the diagnosis and indicate the need for imaging.

Which Imaging Tests Are Used to Confirm Galeazzi Fractures?

To confirm a Galeazzi fracture, several imaging tests may be used:

• X-rays:
  • Standard X-rays: X-rays are the primary imaging tool used to diagnose Galeazzi fractures. They help visualise the fracture of the distal radius and give an image of the dislocation of the distal radioulnar joint. Multiple views (e.g., anteroposterior and lateral) are often needed to fully assess the injury.
• CT Scan (Computed Tomography):
  • CT Scan: CT scans are used if the X-rays do not provide sufficient detail or if the fracture is complex. This imaging technique offers a more detailed view of the bone structures and can help evaluate the extent of the fracture and the alignment of the distal radioulnar joint.
• MRI (Magnetic Resonance Imaging):
  • MRI: While not always required, an MRI may be used if there is concern about soft tissue damage, such as injury to the surrounding ligaments or cartilage. It can provide detailed images of both bone and soft tissues.
• Ultrasound:
  • Ultrasound: In some cases, ultrasound may be used to assess soft tissue injuries or to guide initial treatment, though it is less commonly used for primary diagnosis of Galeazzi fractures.

Access Ortho offers specialist orthopaedic care for acute fractures, sprains, and strains of the upper and lower limbs. Rapid appointments are available. 

Specific Considerations

Galeazzi Fractures in Adults vs. Children

Adults:

• Characteristics: In adults, Galeazzi fractures are often associated with high-impact trauma, such as car accidents or falls from significant heights. The fractures are typically more complex and may involve comminuted (fragmented) distal radius fractures and more severe dislocation of the distal radioulnar joint.
• Treatment: Adults usually require surgical intervention to properly realign and stabilise the fracture and dislocation. Fixation with plates, screws, or pins is often necessary, and recovery might involve more extensive rehabilitation due to the complexity of the injury.

Children:

• Characteristics: In children, Galeazzi fractures are less common but can occur due to falls or sports injuries. Pediatric fractures often involve less severe displacement compared to adults, and the bones in children are generally more flexible and less prone to comminution.
• Treatment: Treatment in children may often be less invasive, with a focus on closed reduction and casting. However, surgery may still be necessary if the fracture and dislocation are severe or if closed reduction fails to maintain proper alignment.

Complications Associated with Galeazzi Fractures

• Infection:
  • Surgical Complications: If surgery is required, there is a risk of infection occurring at the surgical site.
• Nonunion or Malunion:
  • Healing Issues: The fracture may not heal properly, leading to nonunion (failure to heal) or malunion (healing in an incorrect position), which can result in functional impairment.
• Chronic Pain:
  • Long-Term Discomfort: Persistent pain in the wrist or forearm may occur, particularly if the injury is not adequately treated or if complications arise.
• Reduced Range of Motion:
  • Functional Limitations: Reduced range of motion and stiffness in the wrist or forearm can result from the fracture or inadequate rehabilitation.
• Arthritis:
  • Post-Traumatic Arthritis: The dislocation and fracture can lead to post-traumatic arthritis in the wrist or distal radioulnar joint, causing long-term joint pain and stiffness.
• Nerve Injury:
  • Neurological Complications: Damage to nerves around the wrist or forearm may occur, leading to numbness or tingling in the hand or fingers.

Differentiating Galeazzi Fractures from Other Forearm Injuries

• Monteggia Fractures:
  • Difference: A Monteggia fracture involves an ulna fracture with an associated radial head fracture or dislocation, whereas a Galeazzi fracture involves a distal radius fracture along with a dislocation of the distal radioulnar joint. Monteggia fractures affect the ulna and elbow, while Galeazzi fractures affect the radius and wrist.
• Colles Fracture:
  • Difference: A Colles fracture is a specific type of distal radius fracture that occurs with dorsal angulation (the wrist is bent backward). Unlike Galeazzi fractures, it does not involve dislocation of the distal radioulnar joint.
• Smith Fracture:
  • Difference: A Smith fracture is another distal radius fracture but with volar angulation (the wrist is bent forward). This also does not involve the distal radioulnar joint dislocation.
• Radial Head Fractures:
  • Difference: Radial head fractures involve the radial head near the elbow, whereas Galeazzi fractures involve the distal radius near the wrist with a dislocated distal radioulnar joint.
• Distal Ulna Fractures:
  • Difference: A distal ulna fracture alone does not involve a fracture of the radius or dislocation of the distal radioulnar joint, which are key features of a Galeazzi fracture.

In summary, Galeazzi fractures have specific characteristics involving a distal radius fracture and distal radioulnar joint dislocation. Differentiating them from other forearm injuries requires careful consideration of the fracture location, associated dislocation, and clinical presentation. Access Ortho offers specialist care for arm fractures and will assess and determine the best care for your injury. 

Management and Treatment

How Are Galeazzi Fractures Treated?

Treatment of Galeazzi fractures focuses on addressing both the distal radius fracture and the dislocation of the distal radioulnar joint. The approach depends on the severity of the fracture and dislocation and the patient’s overall health.

• Non-Surgical Treatment:
  • Closed Reduction: For less severe Galeazzi fractures, closed reduction involves manually realigning the fractured radius and the dislocated distal radioulnar joint without making an incision. This is typically followed by immobilisation.
  • Casting: After reduction, the wrist and forearm are usually immobilised with a cast or splint to maintain proper alignment during healing.
• Surgical Treatment:
  • Indications: Surgery is often required for more severe fractures, particularly if the fracture is displaced or comminuted or if the dislocation cannot be properly reduced with non-surgical methods.

Surgical Approaches for Galeazzi Fractures

• Open Reduction and Internal Fixation (ORIF):
  • Procedure: The surgeon makes an incision to directly access and realign the fractured radius and the dislocated distal radioulnar joint. Plates, screws, or rods, are used to internally fixate and stabilise the broken bones and maintain alignment.
  • Benefits: This approach allows for precise alignment and stabilisation of the bones, which is crucial for proper healing and function.
• External Fixation:
  • Procedure: In some cases, an external fixator may be used. This device is applied externally to the arm and is connected to the bones via pins or screws. It stabilises the fracture and dislocation from outside the body.
  • Benefits: External fixation can be useful for complex fractures or when internal fixation is not feasible.
• Distal Radioulnar Joint Stabilization:
  • Procedure: The surgeon may address the dislocated distal radioulnar joint specifically through direct stabilisation or by repairing the surrounding ligaments.
  • Benefits: Proper stabilisation of this joint is essential for restoring wrist function and preventing long-term complications.

Rehabilitation and Recovery After Galeazzi Fracture Treatment

• Initial Care:
  • Rest and Immobilisation: The wrist and forearm will be immobilised initially in a cast or splint to allow for bone healing.
  • Pain Management: Pain and inflammation are managed with medications and, if necessary, cold packs.
• Physiotherapy:
  • Start of Rehabilitation: Physical therapy usually begins once the bones have started to heal, which can be several weeks after surgery or cast removal.
  • Exercises: Therapy focuses on regaining range of motion, strength, and movement in the wrist and forearm. Exercises may include stretching, strengthening, and functional activities.
• Monitoring and Follow-Up:
  • Regular Check-ups: Follow-up appointments with the healthcare provider are crucial to monitor healing, adjust treatment as necessary, and address any complications.
  • Imaging: X-rays or other radiology may be used during follow-ups to ensure the bones heal correctly.
• Recovery Time:
  • Timeline: Full recovery can take several months. The initial bone healing typically occurs within 8-12 weeks, but complete functional recovery might extend beyond this period, depending on the injury’s severity and the individual’s response to rehabilitation.

If the orthopaedic team at Access Ortho decides surgery is required, they will assist with finding a suitable surgeon and arranging a referral.

Prevention

Can Galeazzi Fractures Be Prevented?

While Galeazzi fractures cannot always be prevented, you can reduce the risk by taking certain safety measures.

Safety Measures to Reduce the Risk of Forearm Injuries:

• Protective Gear: Protective equipment, such as wrist guards or pads, during high-impact activities or sports.
• Safe Practices: Avoid falls by practising safe techniques during activities and using proper equipment.
• Strength and Flexibility: Maintain strong, flexible muscles around the forearm and wrist through regular exercise and stretching.
• Fall Prevention: Improve home safety by removing tripping hazards and using non-slip mats.
• Proper Training: Learn and use correct techniques for sports or physical activities to minimise injury risk.

Incorporating these safety measures can help reduce the risk of forearm injuries, including Galeazzi fractures.

Outlook / Prognosis

Recovery Time for a Galeazzi Fracture

The recovery time for a Galeazzi fracture varies based on the complexity of the injury, the type of treatment administered, and the patient’s overall health. Generally:

• Initial Healing: Bone healing typically takes about 8-12 weeks. During this period, the fracture should be stabilised by casting or surgical fixation.
• Functional Recovery: Full recovery, including regaining strength, range of motion, and functional use of the wrist and forearm, may take several additional months. Total recovery time can range from 3 to 6 months or longer, depending on the complexity of the fracture and the effectiveness of rehabilitation.

Long-Term Outcomes and Potential Complications

• Long-Term Outcomes:
  • Functional Recovery: Most patients achieve a good functional recovery, with restored wrist and forearm strength and range of motion. However, the extent of recovery can vary.
  • Pain and Stiffness: Some individuals may experience ongoing mild pain or stiffness in the wrist or forearm, especially if the fracture or dislocation is severe.
• Potential Complications:
  • Nonunion or Malunion: The fracture may not heal properly, leading to nonunion (failure to heal) or malunion (healing in an incorrect position), which can cause long-term functional issues.
  • Chronic Pain: Persistent pain in the wrist or forearm can occur, sometimes as a result of improper healing or arthritis.
  • Reduced Range of Motion: Limited movement and stiffness in the wrist or forearm may persist, affecting daily activities.
  • Arthritis: Post-traumatic arthritis in the wrist or distal radioulnar joint can develop, leading to long-term joint pain and stiffness.
  • Nerve Injury: Damage to surrounding nerves may result in numbness or tingling in the hand or fingers.
  • Infection: If surgery is required, there is a risk of infection at the surgical site.

Overall, while many patients recover well from Galeazzi fractures, monitoring for complications and participating in a structured rehabilitation program are essential for optimising long-term outcomes. Access Ortho offers specialist follow-up care for all injuries managed non-surgically. (Injuries that require surgery will be followed up directly by the surgeon who performed the procedure.) Follow-up care with a specialist is essential to minimise complications. 

When to Seek Medical Care

If you suspect a Galeazzi fracture, it’s important to seek medical attention rapidly to ensure appropriate diagnosis and treatment. Access Ortho offers rapid appointments for acute injuries. Contact us today for any concerns. 

Here are key red flags and warning signs indicating when you should see urgent medical care:

Red Flags and Warning Signs for Galeazzi Fractures:

• Severe Pain: Intense pain in the forearm and wrist, especially if it is persistent and severe, even at rest, can indicate a significant injury.
• Visible Deformity: Noticeable deformity or misalignment of the wrist or forearm. If the wrist appears out of place or is visibly deformed, it could be a sign of a fracture and dislocation.
• Inability to Move the Wrist or Forearm: Difficulty or inability to move the wrist or forearm, particularly if it is accompanied by pain, can be a sign of a serious injury.
• Swelling and Bruising: If you have significant swelling and bruising around the wrist and forearm it can indicate a fracture. If swelling is severe or rapidly worsening, it requires immediate attention.
• Numbness or Tingling: Sensations of numbness, tingling, or weakness in the hand or fingers might suggest nerve involvement or compression, which is concerning and requires urgent evaluation.
• Open Wounds: Any open wound or break in the skin near the injury site, especially if bone is visible, needs immediate medical attention to prevent infection and address potential complications.
• Decreased Pulses: Weak or absent pulses in the hand or fingers could indicate compromised blood flow, which is a serious concern and requires emergency care.
• Inability to Bear Weight through the arms or Use the Arm: If the arm cannot be used for daily activities or bear weight, this can indicate a severe fracture or dislocation.

If you observe any of these red flags, it’s crucial to seek emergency medical care. Early intervention is important to properly diagnose and treat Galeazzi fractures, minimise complications, and support a better recovery outcome.

What is a Fracture Clinic?

Role of Fracture Clinics, such as Access Ortho, in Managing Galeazzi Fractures

Fracture clinics are crucial for:

• Diagnosis and Treatment: Assessing and planning treatment for Galeazzi fractures, including possible surgery.
• Post-Operative Care: Managing wound care, pain, and cast or splint care after surgery.
• Rehabilitation: Coordinating physical therapy and providing exercise guidance.
• Monitoring and Follow-Up: Scheduling regular check-ups, adjusting treatment plans, and ensuring proper healing.
• Education and Support: Offering patient education, support, and resources for recovery.

Access Ortho will provide the above care; if you require surgery for your injury, you can quickly get an orthopaedic opinion and help to arrange a suitable surgeon. 

What to Expect During Fracture Clinic Follow-Ups

Access Ortho offers follow-up appointments in the clinic with an Orthopaedic Consultant. At your follow-up appointments, you can expect the following:

• Evaluation: Checking healing progress and conducting imaging studies.
• Treatment Adjustments: Modifying the treatment plan based on progress and any new issues.
• Rehabilitation Progress: Arranging physiotherapy if required.
• Addressing Complications: Identifying and managing any complications that arise.
• Patient Education: Providing guidance on recovery, self-care, and returning to normal activities.

Access Ortho Fracture Clinic ensures comprehensive care and support throughout the recovery process for Galeazzi fractures.

Commonly Asked Questions

What is the difference between a Galeazzi fracture and a Monteggia fracture?

• A Galeazzi Fracture involves a fracture of the distal radius in conjunction with a dislocation of the distal radioulnar joint.
• A Monteggia Fracture involves the other bone in the forearm, the ulna (often mid-shaft) with an associated fracture or dislocation of the radial head at the elbow.

Can a Galeazzi fracture heal without surgery?

It is less common for Galeazzi fractures to heal without surgery, particularly if the fracture is displaced or if there is significant dislocation. Non-surgical treatment may be considered for less severe cases, but surgical intervention is often required for proper alignment and stabilisation.

How long does it take to recover from a Galeazzi fracture?

• Initial Healing: Bone healing typically takes about 8-12 weeks.
• Full Recovery: Complete functional recovery, including regaining strength and range of motion, may take 3-6 months or longer, depending on the severity and treatment.

What are the long-term effects of a Galeazzi fracture?

Potential long term effects include chronic pain, reduced range of motion, stiffness, post-traumatic arthritis, and possible nerve injury. Long-term outcomes depend on the severity of the injury and the effectiveness of treatment.

Is a Galeazzi fracture considered a severe injury?

Galeazzi fractures are considered severe due to the combination of a distal radius fracture and dislocation of the distal radioulnar joint, which often requires surgical intervention and can lead to significant complications if not treated properly.

Can children get Galeazzi fractures?

Children can get a Galeazzi fracture, though they are less common compared to adults. Treatment in children may often be less invasive, but severe cases may still require surgery.

What activities should be avoided after a Galeazzi fracture?

After a Galeazzi fracture, you should avoid high-impact activities, sports that involve the risk of falling or direct trauma to the wrist, and any strenuous use of the injured arm until fully recovered and cleared by a healthcare provider.

How is a Galeazzi fracture different from a simple radius fracture?

• Galeazzi Fracture: Involves a distal radius fracture that is associated with a dislocation of the distal radioulnar joint.
• Simple Radius Fracture: Involves only a fracture of the radius without associated dislocation of the distal radioulnar joint.

What are the signs of a missed Galeazzi fracture?

The signs you may experience if you have a missed Galeazzi fracture are persistent pain, swelling, and functional impairment in the wrist or forearm, despite initial treatment. Difficulty with wrist movement and potential deformity may also indicate a missed Galeazzi fracture. These symptoms could also be signs of another injury; you should seek urgent medical care for any of these symptoms. 

When can I return to work or sports after a Galeazzi fracture?

• Return to Work: Light work can typically be resumed after a few weeks, depending on the job’s physical demands and the healing progress.
• Return to Sports: Usually after 3-6 months, once healing is complete and functional recovery is sufficient. Consult with your medical team for specific recommendations based on your individual recovery process.