Case 16 - Galeazzi's Injury

A 12 year old male is brought to the ED after injuring his forearm rollerblading. He fell onto his palm and noted pain and a deformity in his forearm. Examination revealed normal vital signs and findings limited to his left arm. His clavicle, shoulder, humerus, and hand were non-tender. He was reluctant to move his shoulder since his forearm was in a splint and sling. There was an obvious angulation at the mid-forearm. He could move all his fingers. No circulatory or sensory deficits were detected. Radiographs of his forearm were obtained.  

View radiographs. 

The radiographs show an angulated distal radius and ulna fracture, a fracture through the physis of the distal ulna, and a dislocation of the distal ulna (radioulnar dislocation). What type of Salter-Harris fracture is present at the distal ulna? If you have difficulty with the Salter-Harris classification, review Case 18 (Salter-Harris). This is probably a SH type I fracture, although small parts of the metaphysis may still be attached to the fracture segment, making it a type II. The classic Galeazzi fracture is described as a fracture of the distal third of the radius associated with a dislocation of the distal ulna.

This classic injury occurs more commonly in adults and teenagers than in younger children. It may be very difficult to recognize since the radioulnar joint is painful and difficult to examine in the presence of an adjacent radius fracture. The radioulnar joint may spontaneously reduce in some instances. Orthopedic surgeons usually examine the radioulnar joint stability during reduction of the radius fracture or by using more advanced imaging methods. One should be suspicious of the Galeazzi fracture in any angulated fracture of the distal radius. Radioulnar dislocation is unlikely in simple non-angulated torus-type distal radius fractures.

A Galeazzi-like injury occurs in children. The ligaments of the distal forearm normally prevent the radius and ulna from twisting about each other. As the distal radius fractures, exaggerated twisting forces in the hyperpronation or hypersupination direction result in the loss of stabilization of the radioulnar attachments. Ligaments attaching the distal ulnar epiphysis to the distal radius and the carpal/metacarpals gain tension on the ulnar head as twisting occurs. If the tension force is great enough, the ulnar physis fractures. Recognizing a Salter-Harris type I or II fracture of the ulnar physis associated with a distal radius fracture should cause one to consider the possible complications of th e Galeazzi fracture.

If the Galeazzi injury is not recognized, the radioulnar dislocation may not be identified. This can result in a painful prominence of the distal ulna. Occasionally, the extensor digitorum communis tendon may become entrapped between the ulnar epiphysis and metaphysis in children, making closed reduction impossible.

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