Galeazzi Fractures – Causes, Symptoms, Treatment

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Galeazzi Fractures most commonly result from a fall onto an outstretched hand with an extended wrist and hyperpronated forearm. The energy from the radius fracture gets transmitted towards the radioulnar joint leading to dislocation of the DRUJ. These fractures occur with a bimodal distribution, diaphyseal forearm fractures in young males are commonly due to high-energy trauma (e.g., sports injuries, falls from height, motor vehicle collisions) and fractures in aging females are due to low-energy traumas such as falls from ground level.

Classification System of Galeazzi Fractures

Two classification systems have been proposed when categorizing Galeazzi fractures.

The first classifications were based on the position of the distal radius:

Type I: Dorsal displacement

Type II: Volar displacement

The second classification system is based on Rettig ME and Raskin KB who categorized Galeazzi fractures based on fracture stability. They found stability to be dependent on the distance of the radial fracture from the distal radial articular surface:

Type I:

  • Fracture occurring distally from the 7.5 cm demarcation (i.e., closer to the wrist)
  • Associated with significant DRUJ instability in more than 50% of cases

Type II:

  • Fracture occurring proximally from the 7.5 cm demarcation (i.e., further from the wrist)
  • Associated with significant DRUJ instability in only around 5% of cases

Causes of Galeazzi Fractures

Colles’ fracture

 

  • Sudden forceful  fall down
  • Road traffic accident
  • Falls – Falling onto an outstretched hand is one of the most common causes of a broken distal radius.
  • Sports injuries – Many distal radius fractures occur during contact sports or sports in which you might fall onto an outstretched hand — such as in-line skating or snowboarding.
  • Motor vehicle crashes – Motor vehicle crashes can cause wrist bones to break, sometimes into many pieces, and often require surgical repair.
  • Have osteoporosis –  a disease that weakens your bones
  • Eave low muscle mass or poor muscle strength – or lack agility and have poor balance (these conditions make you more likely to fall)
  • Walk or do other activities in the snow or on the ice – or do activities that require a lot of forwarding momenta, such as in-line skating and skiing
  • Wave an inadequate intake of calcium or vitamin D
  • Football or soccer, especially on artificial turf
  • Rugby
  • Horseback riding
  • Hockey
  • Skiing
  • Snowboarding
  • In-line skating
  • Jumping on a trampoline

Symptoms Of Galeazzi Fractures

Common symptoms of a distal radius fractures include:

  • Severe pain that might worsen when gripping or squeezing or moving your hand or wrist
  • Swelling
  • Tenderness
  • Bruising
  • Obvious deformity, such as a bent wrist
  • Pain
  • Bruising
  • Tenderness
  • The wrist hanging in a deformed way
  • Pain, especially when flexing the wrist
  • Deformity of the wrist, causing it to look crooked and bent.
  • Your wrist is in great pain.
  • Your wrist, arm, or hand is numb.
  • Your fingers are pale.

Galeazzi Fractures

Diagnosis of Galeazzi Fractures

Imaging

If a forearm fracture and dislocation are suspected, radiographs are warranted. An anteroposterior and lateral view will usually identify the injury. An additional oblique view may help better classify the injury. Additional radiographs of the distal wrist and proximal elbow should be obtained with any suspicion of coexistent injury.

If a distal to mid-shaft radial fracture is seen on the radiograph, a close examination of the DRUJ is merited. Signs of DRUJ disruption include:

  • Widening of the DRUJ on the PA view
  • Ulnar styloid fracture
  • Displacement of the ulna dorsally on the lateral view
  • Radial shortening greater than 5 mm (would need to compare with unaffected limb)

Usually, advanced imaging is not needed for an initial assessment. For pre-operative planning, a CT scan may be used to evaluate for non-union, and magnetic resonance imaging (MRI) can help evaluate for TFCC tears and interosseous membrane disruption.

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Treatment / Management of Galeazzi Fractures

All suspected or confirmed Galeazzi fractures will require orthopedist consultation. While awaiting consult, patients should be placed in a sugar-tong splint. In most cases, conservative management is indicated in children while surgical intervention is warranted in adults. Prior reports suggested treatment with closed reduction and immobilization alone, in adults, yielded poor outcomes in greater than 90% of patients.

Initial Management

Initial management for a presumed fracture includes rest, ice, immobilization, and elevation. In most cases, closed reduction of the radius followed by a reduction of the ulna in the DRUJ should be attempted in the acute setting.

Pediatrics

Children tend to have overall better long-term outcomes compared to adults. The approach is usually conservative with closed reduction and splinting. Above-elbow casting in supination is the preferred immobilization. Irreducible and unstable injuries, as well as variants of the Galeazzi fracture, may require surgical intervention with open reduction and internal fixation (ORIF).

Non-Surgical

Treatment available can be broadly

  • Get medical help immediately – If you fall on an outstretched arm, get into a car accident or are hit while playing a sport and feel intense pain in your shoulder area, then get medical care immediately. Distal radius fractures cause significant pain in the front part of your shoulder, closer to the base of your neck. You’ll innately know that something is seriously wrong because you won’t be able to lift your arm up. Other symptoms include immediate swelling and/or bruising near the fracture, grinding sounds with arm movements and potential numbness and tingling in the arm/hand.
  • Apply ice to your fractured clavicle – After you get home from the hospital distal radius fractures (regardless if you had surgery or not), you should apply a bag of crushed ice (or something cold) to your injured in order to reduce the swelling and numb the pain. Ice therapy is effective for acute (recent) injuries that involve swelling because it reduces blood flow by constricting local blood vessels. Apply the crushed ice to your clavicle for 15 minutes three to five times daily until the soreness and inflammation eventually fades away
    Lightly exercise after the pain fades – After a couple of weeks when the swelling has subsided and the pain has faded away, remove your arm sling for short periods and carefully move your arm and shoulder in all different directions. Don’t aggravate the distal radius fractures so that it hurts, but gently reintroduce movements to the involved joints and muscles. Start cautiously, maybe starting with light calisthenics and then progress to holding light weights (five-pound weights to start). Your distal radius fractures need to move a little bit during the later phases of the injury to stimulate complete recovery.
  • Practice stretching and strengthening exercises – of the fingers, elbow, and shoulder if your doctor recommends them.
  • A splint – which you might use for a few days to a week while the swelling goes down; if a splint is used initially, a cast is usually put on about a week later.
  • A cast – which you might need for six to eight weeks or longer, depending on how bad the break is (you might need a second cast if the first one gets too loose after the swelling goes away.)
  • Get a supportive arm sling – Due to their anatomical position, distal radius fractures can’t be cast like a broken limb can. Instead, a supportive arm sling or “figure-eight” splint is typically used for support and comfort, either immediately after the injury if it’s just a hairline fracture or following surgery, if it’s a complicated fracture. A figure-eight splint wraps around both shoulders and the base of your neck in order to support the injured shoulder and keep it positioned up and back. Sometimes a larger swath of material is wrapped around the sling to keep it closer to your body. You’ll need to wear the sling constantly until there is no pain with arm movements, which takes between two to four weeks for children or four to eight weeks for adults.
  • Get a referral to physical therapy – Once you’ve recovered and able to remove your arm sling splint for good, you’ll likely notice that the muscles surrounding your shoulder and upper chest look smaller and feel weaker. That’s because muscle tissue atrophies without movement. If this occurs, then you’ll need to get a referral for some physical rehabilitation. Rehab can start once you are cleared by your orthopedist, are pain-free, and can perform all the basic arm and shoulder movements. A physiotherapist or athletic trainer can show you specific rehabilitation exercises and stretches to restore your muscle strength, joint movements, and flexibility
  • Rigid fixation – osteosynthesis with locking plate, hook plate fixation, fixation with a distal radius locking plate, coracoclavicular screws, Knowles pin fixation.
  • Flexible fixation – simple k wire fixation, tension band wiring, suture anchors, vicryl tape, dacron arterial graft for coracoclavicular ligament reconstruction.
  • A splint – which you might use for a few days to a week while the swelling goes down; if a splint is used initially, a cast is usually put on about a week later.
  • A cast – which you might need for six to eight weeks or longer, depending on how bad the break is (you might need a second cast if the first one gets too loose after the swelling goes away.)
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Rest Your Hand

Once you’re discharged from the hospital in an arm sling, your top priority is to rest your shoulder and not further inflame the injury. Of course, the arm sling not only provides support, but it also restricts movement, which is why you should keep it on even during sleep. Avoiding the temptation to move your shoulder and arm will help the bone mend quicker and the pain fades away sooner.
  • Depending on what you do for a living and if the injury is to your dominant side, you may need to take a couple of weeks off work to recuperate.
  • Healing takes between four to six weeks in younger people and up to 12 weeks in the elderly, but it depends on the severity of the fractured clavicle.
  • Athletes in good health are typically able to resume their sporting activities within two months of breaking they’re ulnar styloid depending on the severity of the break and the specific sport.
  • Sleeping on your back (with the sling on) is necessary to keep the pressure off your shoulder and prevent stressing the clavicle injury.

Eat Nutritiously During Your Recovery

All bones and tissues in the body need certain nutrients in order to heal properly and in a timely manner. Eating a nutritious and balanced diet that includes lots of minerals and vitamins is proven to help heal broken bones of all types, including ulnar styloid. Therefore, focus on eating lots of fresh produce (fruits and veggies), whole grains, lean meats, and fish to give your body the building blocks needed to properly repair your clavicle. In addition, drink plenty of purified water, milk, and other dairy-based beverages to augment what you eat.

  • Broken bones need ample minerals (calcium, phosphorus, magnesium, boron) and protein to become strong and healthy again.
  • Excellent sources of minerals/protein include dairy products, tofu, beans, broccoli, nuts and seeds, sardines and salmon.
  • Important vitamins that are needed for bone healing include vitamin C (needed to make collagen), vitamin D (crucial for mineral absorption), and vitamin K (binds calcium to bones and triggers collagen formation).
  • Conversely, don’t consume food or drink that is known to impair bone/tissue healing, such as alcoholic beverages, sodas, most fast food items and foods made with lots of refined sugars and preservatives.
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Physical Therapy

  • Although there will be some pain, it is important to maintain arm motion to prevent stiffness. Often, patients will begin doing exercises for elbow motion immediately after the injury.  After a proximal ulna fracture, it is common to lose some shoulder and arm strength. Once the bone begins to heal, your pain will decrease and your doctor may start gentle shoulder exercises. These exercises will help prevent stiffness and weakness. More strenuous exercises will be started gradually once the fracture is completely healed.

Follow-Up Care

  • You will need to see your doctor regularly until your fracture heals. During these visits, he or will take x-rays to make sure the bone is healing in a good position. After the bone has healed, you will be able to gradually return to your normal activities.

Breathing Exercise

  • To elevate breathing problem or remove the lung congestion if needed.

Medication

References

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