6/21/2023 0 Comments Galeazzi fracture posnaThe radial shaft fracture is first repaired with rigid fixation. Surgical intervention is the preferred intervention. Multiple reports have shown high rates of nonunion and secondary displacements with conservative management. Irreducible and unstable injuries, as well as variants of the Galeazzi fracture, may require surgical intervention with open reduction and internal fixation (ORIF).Īdults tend to have poor outcomes with closed reduction and immobilization. Above-elbow casting in supination is the preferred immobilization. The approach is usually conservative with closed reduction and splinting. In most cases, closed reduction of the radius followed by reduction of the ulna in the DRUJ should be attempted in the acute setting.Ĭhildren tend to have overall better long-term outcomes compared to adults. Initial management for a presumed fracture includes rest, ice, immobilization, and elevation. Prior reports suggested treatment with closed reduction and immobilization alone, in adults, yielded poor outcomes in greater than 90% of patients. In most cases, conservative management is indicated in children while surgical intervention is warranted in adults. While awaiting consult, patients should be placed in a sugar-tong splint. Ulnar nerve injury is rare.Īll suspected or confirmed Galeazzi fractures will require orthopedist consultation. Although nerve injury is less common, examination of the median and radial nerve distribution is essential in identifying nerve damage. Inquire about weakness, numbness, paresthesias, and radiating pain. High mechanism crush injuries merit a detailed neurovascular exam with repeat serial exams looking for signs of acute compartment syndrome. A fall on an outstretched hand should raise suspicion for a wrist injury, and particular attention should be paid to the stability of the DRUJ. Stability of the proximal and distal joints should be assessed to identify concomitant injuries. Gentle palpation should be performed to identify deformities and focal tenderness. It is essential to identify wounds overlying fracture sites (i.e., open fracture), which necessitates immediate surgical intervention. An examination should begin with a visual inspection of the skin and soft tissue paying close attention to visible bony deformities, skin lacerations, muscle contusions, tendon damage and neurovascular deficits. Patients with diaphyseal forearm fractures typically complain of pain at the site of injury. They found stability to be dependent on the distance of the radial fracture from the distal radial articular surface: The second classification system is based on Rettig ME and Raskin KB who categorized Galeazzi fractures based on fracture stability. The first classifications were based on the position of the distal radius: Two classification systems have been proposed when categorizing Galeazzi fractures. Distally the radius connects with the lunate and scaphoid bones of the wrist. The proximal radial head articulates with the capitellum of the humerus (radiocapitellar joint), rotating within the annular ligament during pronation and supination. Distally the ulnar head serves as an insertion point for the TFCC, supplementing the DRUJ. Proximally the ulna consists of the olecranon and coronoid. The radiocapitellar joint largely stabilizes the proximal forearm while the TFCC predominantly supports the distal forearm. The interosseous membrane is responsible for dispersing axial load force to the forearm, 60% to the radiocapitellar joint and 40% to the ulnohumeral joint. The radius and ulna are stabilized by three groups of ligamentous structures: distally the triangular fibrocartilage complex (TFCC), the interosseous membrane, and proximally the annular ligament. The osseous forearm is composed of the radius and ulna bones.
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