Sie sind auf Seite 1von 5

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/260396045

Galeazzi Fractures: our Modified Classification and Treatment Regimen

Article in Handchirurgie · Mikrochirurgie · Plastische Chirurgie · February 2014


DOI: 10.1055/s-0034-1367035 · Source: PubMed

CITATIONS READS

0 1,085

2 authors:

Hangama C Fayaz Jesse Jupiter


Massachusetts General Hospital Harvard Medical School
25 PUBLICATIONS 121 CITATIONS 374 PUBLICATIONS 13,603 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Lost in Translation: A German Disease or a Global Issue View project

From Himalayas across Rockies to the Alps: Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an
International Perspective. Vom Hindukusch über Rockies in die Alpen: Verbesserung der Facharztausbildung im Bereich Orthopädie und Unfallchirurgie
und Integration View project

All content following this page was uploaded by Hangama C Fayaz on 15 January 2015.

The user has requested enhancement of the downloaded file.


Personal pdf file for
H. C. Fayaz, J. B. Jupiter

With compliments of Georg Thieme Verlag www.thieme.de

Galeazzi Fractures: our


Modified Classification
and Treatment Regimen

DOI 10.1055/s-0033-1367035
Handchir Mikrochir Plast Chir 2014; 46: 31–33

For personal use only.


No commercial use, no depositing in repositories.

Publisher and Copyright


© 2014 by
Georg Thieme Verlag KG
Rüdigerstraße 14
70469 Stuttgart
ISSN 0722-1819

Reprint with the


permission by the
publisher only
Original Article 31

Galeazzi Fractures: our Modified Classification


and Treatment Regimen
Galeazzi-Frakturen: unser modifiziertes Klassifikations-
und Behandlungsregim

Authors H. C. Fayaz, J. B. Jupiter

Affiliation Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston,
Massachusetts, USA

Key words Abstract Zusammenfassung


●▶ Galeazzi fracture ▼ ▼
●▶ Galeazzi like lesion
While diaphyseal fractures of the forearm are a Galeazzi-Frakturen sind weder einfach zu erken-nen,
●▶ modified classification
common orthopedic injury, Galeazzi fractures are noch zu behandeln. Neuere Erkenntnisse die
Schlüsselwörter difficult to treat. The current knowledge on Pathobiomechanik betreffend verlangen nach einer
●▶ Galeazzi-Fraktur pathobiomechanics and modified therapeutic decisions Überarbeitung der Klassifikation und zugleich des
●▶ Galeazzi like lesion implicate the need to devise an updated classification Behandlungskonzepts. Nach unserer Meinung sollte
●▶ modifizierte Klassifikation and treatment regimen of Galeazzi fractures. We jede isolierte Radiusfraktur so lange als Galeazzi-
challenge the concept that isolated fractures of the Fraktur betrachtet werden, bis die Stabilität des
radius should be considered as a Galeazzi fractures as distalen Radioulnargelenkes bewiesen ist. Im
long as stability of the distal radioulnar joint is not Gegensatz zu anderen Autoren sind wir nicht der
proven. Contrary to others we demonstrate that the Meinung, dass allein die Loka-lisation der Fraktur
fracture location alone is not sufficient to determine the schon eine Aussage zur Sta-bilität des distalen
stability of the distal radioulnar joint. Radioulnargelenkes zulässt.

Similar to Monteggia fractures, and Essex-Lopresti chanics and therapeutic decisions to devise an
lesions, Galeazzi fractures occur as com-bined updated classification and treatment regimen ( ●▶
injuries of the forearm (●▶ Fig. 1). These injury Fig. 2, 3).
patterns typically include a fracture of either the I Isolated diaphyseal (proximal or middle-third)
radius or ulna of the forearm with dis-location of fractures of the radius
either the proximal or distal radioul-nar joint II Diaphyseal fractures of the radius and ≥ 5 mm
(DRUJ). Failure to diagnose these fracture- ulnar positive variance
received 16.8.2011
accepted 20.1.2014 dislocations accounts for a high inci-dence of IIa Stable DRUJ (acute TFCC tears: 1A, 1D)
unsatisfactory results. Galeazzi fracture was first IIb Partially Stable DRUJ (acute TFCC tears:
Bibliography described by Sir Astley Cooper in 1822, but was 1B, 1C) IIc Unstable DRUJ (simple or complex)
DOI http://dx.doi.org/ named after the Italian surgeon Riccardo Galeazzi, As reported by Nicolaidis et al., Lichtman and Col-lins
10.1055/s-0034-1367035 who presented 18 cases of this fracture in 1934 [1]. combined classification of DRUJ injuries, stable DRUJ
Handchir Mikrochir Plast According to Mikic in 1975, the Galeazzi fracture is injuries include types 1A and 1D triangular
Chir 2014; 46: 31–33 fibrocartilage complex (TFCC) tears and are recog-
a fracture of the middle to distal third of the radius
© Georg Thieme Verlag
and is associated with dislocation and/or instability nized as “nondestabilizing TFCC tears” [7].
KG Stuttgart · New York
of the DRUJ [2]. Galeazzi fractures are associated In these injuries, the dorsal and palmar radioul-nar
ISSN 0722-1819
with poor out-comes with closed reduction and cast ligaments generally remain intact. While types 1B and
Correspondence immobili-zation. Campbell has referred to this 1C TFCC tears lead to a partial desta-bilization, type
Hangama C. Fayaz MD, PhD fracture as the fracture of necessity [3]. 1C also includes an ulnocarpal disruption. An extensor
Department of Orthopaedic Classification schemes of Galeazzi fractures were carpi ulnaris subluxation is also recognized as a partial
Surgery, Harvard Medical destabilizing factor. According to Nicolaidis et al., a
described by Bruckner et al. in 1992 [4], Macule et
School, Massachusetts
al. in 1994 [5], and Rettig and Raskin in 2001 [6]. ●▶ massive tear of the TFCC as well as ulnar styloid
General Hospital, Yawkey
Center, Suite 2100, 55 Fruit
Table 1–3 provide useful starting guidelines but avulsion and a distal radius fracture will lead to a
Street, Boston, Massachusetts may not always apply to individual treatment complete rup-ture of the TFCC, which is classified as
USA options.We have utilized current knowledge on an unsta-ble DRUJ injury-dislocation [7].
dr.hana.fayaz@hotmail.de pathobiome-

Fayaz HC, Jupiter JB. Galeazzi Fractures: our Modified … Handchir Mikrochir Plast Chir 2014; 46: 31–33
32 Original Article

a Comments on Type I

Based on findings by Mestdagh et al., Hattoma et al., and Rettig
and Raskin [6,8,9], we challenge the concept that isolated frac-
tures of the radius are always Galeazzi fractures. Contrary to
Rettig and Raskin, we demonstrate that the fracture location
alone is not sufficient to determine the stability of the DRUJ.
Which indicates that the distinction of lesions with greater DRUJ
b injury cannot be based solely upon fracture location.

Comments on Type II

These studies are based on biomechanical studies, which have
Fig. 1 a, b Isolated fractures of the radius (Type I).
shown that greater than 5 mm of ulnar positive variance dis-
placement indicates injury to all of the soft tissue stabilizers of
the DRUJ.
Table 1 Classification of Galeazzi fractures according to Macule et al. [5].
type I – fracture of the radius occurs between 0 and 10 cm from the
styloid process Galeazzi-like Lesion
type II – fracture of the radius occurs between 10 and 15 cm from the ▼
styloid process In Galeazzi-like lesions, a fracture of the radial shaft is associated with
type III – fracture of the radius occurs more than 15 cm from the styloid
an additional fracture of the distal ulna. Road traffic acci-dents are the
process
main etiology of this type of injury [6]. An essential soft tissue stabilizer
of the DRUJ is the TFCC. Rupture of this complex typically occurs
secondary to extreme pronation and extension of the wrist [10,11].
Table 2 Classification of Galeazzi fractures and treatment concept by Rettig
According to Renfree and Ring in 2004 and 2006, injury to the DRUJ
and Raskin [6].
occurs in 20 % of Galeazzi frac-tures, and by this logic, any fracture of
type I – Distance between the midarticular surface of the distal radius
the distal third of the radius should be considered a Galeazzi fracture
and the fracture is within 7.5 cm. DRUJ joint more unstable, when
tested intraoperatively. and the DRUJ should be carefully examined [12,13]. However, in our
type II – Distance between the midarticular surface of the distal radius review of the current literature, we support the concept established in
and the fracture is more than 7.5 cm. Only 6 % of patients required Europe that isolated fractures of the radius occur more often without
ORIF of the DRUJ. major associated DRUJ ligament injury [8].

Table 3 Radiographic signs that lead to the Galeazzi diagnosis [15].


– fracture at the base of the ulnar styloid Non-operative Treatment
– widening of the DRUJ-Joint space (on a true antero posterior view) ▼
– dislocation of the radius relative to the ulna (on a true lateral view) Conservative treatment of Galeazzi fractures is associated with
– more than 5 mm of shortening of the radius relative to the ulna
a high percentage of malfunction. In 1957, Hughston outlined
the factors that cause a loss of reduction as follows: 1) thumb
abduc-tors and extensors trigger shortening and relaxation of
a b
the radial collateral ligament, which inhibits stretching of the soft
tissue bridge, 2) subluxation of the DRUJ may be induced by
gravity acting through the weight of the hand, 3) the
brachioradialis uses DRUJ as a pivot point on which to rotate
the distal fragment of the radius and results in shortening, 4)
insertion of the prona-tor quadratus on the palmar surface of the
distal radius fragment rotates it towards the ulna and pulls it in a
proximal, palmar direction [14].

Operative Treatment

Surgical management of Galeazzi fractures consists of a palmar
approach to the radial shaft. All patients undergo open reduc-
tion and fracture stabilization with a 3.5 mm AO dynamic com-
pression plate or low contact dynamic compression plate
applied to the palmar surface. Following anatomic fixation, the
DRUJ should be clinically evaluated for forearm supination
Fig. 2 a, b Showing the displacement; space between DRUJ and ulnar
stability. Gross instability of the DRUJ should be identified.
positive variance (Type II).

Fayaz HC, Jupiter JB. Galeazzi Fractures: our Modified … Handchir Mikrochir Plast Chir 2014; 46: 31–33
Original Article 33

a b c
Fig. 3 a Stable DRUJ, minimal displacement (Type
IIa) b Partially Stable DRUJ (Type IIb) c Unstable
DRUJ (Type IIc).

outlined a precise treatment regimen indicating the need for


Fig. 4 Showing a substantial DRUJ
casting and wrist arthroscopy in stable DRUJ cases and repair
displacement that has been treated
of TFCC in unstable DRUJ. They recommend a reduction of
by ORIF of the ulnar styloid, using
Kirschner wires with a tension
DRUJ, crossing Kirchner wires, and repair of the ulnar styloid in
band and ORIF of the radius. unsta-ble DRUJ cases [7].

Conflict of interest: None

References
1 Galeazzi R. Über ein besonderes Syndrom bei Verletzungen im Bereich
der Unterarmknochen. Arch Orthop Unfallchir 1934; 35: 557–562
2 Mikic ZD. Galeazzi fracture-dislocations. J Bone Joint Surg Am 1975;
57: 1071–1080
3 Campbell RM Jr. Operative treatment of fractures and dislocations of the
hand and wrist region in children. Orthop Clin North Am 1990;
21: 217–243
4 Bruckner JD, Lichtman DM, Alexander AH. Complex dislocations of the
distal radioulnar joint. Recognition and management. Clin Orthop Relat
Res 1992; 275: 90–103
5 Macule F, Arandes JM, Ferreres C et al. Treatment of Galeazzi fracture
dislocations. J Trauma 1994; 36: 352–355
6 Rettig ME, Raskin KB. Galeazzi fracture-dislocation: a new treatment-
oriented Classification. J Hand Surg Am 2001; 26: 228–235
Surgical Technique 7 Nicolaidis SC, Hildreth DH, Lichtman DM. Acute injuries of the distal
▼ radioulnar joint. Hand Clin 2000; 16: 449–459
8 Hattoma N, Rafai M, Zahar A et al. Lesions of the distal radio-ulnar joint
The Henry approach is the preferred method for surgical treat- associated with isolated fractures of the radial shaft. Acta Orthop Belg
ment of Galeazzi fractures. After fracture reduction, stable fixa- 2002; 68: 476–480
9 Mestadagh H, Duquennoy A, Letendart J et al. Long-term results in the
tion is performed by applying a DCP plate. A minimum of 6
treatment of fracture-dislocations of Galeazzi in adults. Report on twenty-
cortices on either side of the fractures is inserted. Initially, the nine cases. Ann Chir Main 1983; 2: 125–133
plate is fixed with 2 screws, and X-ray is then used to confirm 10 Almquist EE. Evolution of the distal radioulnar joint. Clin Orthop Relat Res
the accuracy of fracture reduction and precision of DRUJ reduc- 1992; 275: 5–13
11 Wallace AL, Walsh WR, Van Rooijen M et al. The interosseous ligament
tion. Forearm stability should also be tested by passively rota-
in radio-ulnar dissociation. J Bone Joint Surg Br 1997; 79: 422–427
tion. According to Mudgal and Jupiter, if there is no forearm 12 Renfree KJ. Shaft fractures of the radius and ulna. In: Berger RA, Weiss
instability, then postoperative immobilization is not mandatory. APC(eds.). Hand Surgery. Philadelphia: Lippincott Williams & Wilkins;
The authors also indicated that if “the DRUJ is reducible but 2004
13 Ring D, Rhim R, Carpenter C et al. Isolated radial shaft fractures are more
unstable with forearm rotation,” then in this situation they common than Galeazzi fractures. J Hand Surg Am 2006; 31: 17–21
offered several treatment options depending upon whether the 14 Hughston JC. Fracture of the distal radial shaft; mistakes in manage-
ulnar styloid had been fractured at its base. An open reduction ment. J Bone Joint Surg Am 1957; 39: 249–264
and internal fixation (ORIF) of the ulnar styloid (using Kirschner 15 Moore TM, Klein JP, Patzakis MJ et al. Results of compression plating of
closed Galeazzi fractures. J Bone Joint Surg Am 1985; 67: 1015–1021
wires with a tension band or small screw) has been recom- 16 Strehle J, Gerber C. Distal radioulnar joint function after Galeazzi frac-ture
mended (●▶ Fig. 4). However, according to Moore et al. and dislocations treated by open reduction and internal plate fixation. Clin
Strehle and Gerber, 4 weeks of immobilization appears to be Orthop Relat Res 1993; 293: 240–245
sufficient for DRUJ healing [15,16]. In 2000, Nicolaidis et al.

Fayaz HC, Jupiter JB. Galeazzi Fractures: our Modified … Handchir Mikrochir Plast Chir 2014; 46: 31–33
View publication stats