## Investigation of Choice for Galeazzi Fracture-Dislocation ### Diagnostic Imaging Hierarchy **Key Point:** Plain radiographs (AP and lateral views) of the entire forearm and wrist are the gold standard for diagnosing Galeazzi fracture-dislocation. The classic findings include: 1. Fracture of the distal third of the radius 2. Dislocation of the distal radioulnar joint (DRUJ) 3. Disruption of the interosseous membrane ### Essential Radiographic Views **High-Yield:** The diagnostic protocol requires: - **Anteroposterior (AP) view** — shows radial fracture and DRUJ alignment - **Lateral view** — demonstrates dorsal displacement of the ulnar head (most common) - **Both forearm and wrist** — captures the entire injury pattern from radius to DRUJ ### DRUJ Assessment on Plain Films **Clinical Pearl:** The DRUJ dislocation is confirmed on plain radiographs by: - Loss of the normal overlap of the radius and ulna on AP view - Dorsal displacement of the ulnar head on lateral view - Widening of the DRUJ space These findings are sufficient for diagnosis and do not require advanced imaging. ### Why Advanced Imaging Is Not First-Line **Warning:** Common misconception — CT is NOT needed for initial diagnosis. CT is reserved for: - Comminuted radial fractures requiring surgical planning - Evaluation of intra-articular extension - Assessment of associated carpal injuries MRI is used only when soft-tissue injury (triangular fibrocartilage complex [TFCC], ligaments) is suspected and affects management. ### Arthroscopy Role **Tip:** Arthroscopy is a therapeutic intervention (for TFCC repair) and is NOT a diagnostic investigation. It is performed intraoperatively after diagnosis is established. [cite:Rockwood and Green's Fractures in Adults 9e Ch 22] 
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